Division of Hematology/Oncology, Georgetown University Hospital, Lombardi Comprehensive Cancer Center, Washington, DC, USA.
Department of Medicine, University of Washington, Seattle, Washington, USA.
Hematol Oncol. 2021 Dec;39(5):697-706. doi: 10.1002/hon.2925. Epub 2021 Sep 9.
Older age and poor performance status lead to worse outcomes in acute myeloid leukemia (AML) patients. Hypoalbuminemia is a negative predictor of morbidity and mortality in several malignancies. We evaluated the relationship between baseline serum albumin levels on treatment-related complications, as well as short-term mortality and overall survival (OS) in 756 newly diagnosed AML patients. We conducted a retrospective multicenter study to examine treatment-related complications and OS according to pretreatment serum albumin levels: normal albumin ≥3.5 g/dl, marked hypoalbuminemia <2.5 g/dl, and hypoalbuminemia 2.5-3.4 g/dl. In an adjusted multivariate analysis, a lower baseline albumin was independently associated with a higher number of grade ≥3 complications when adjusting for age, secondary AML, sex and intensive treatment. When comparing normal to markedly low albumin levels, the estimated mean number of complications increases by a factor of 1.35. Patients who had a normal baseline albumin had a 30 day-mortality rate of 4.8%, which was significantly lower compared with patients with hypoalbuminemia (16.5%) and marked hypoalbuminemia (33.9%; p < 0.01). Similarly, 60-day mortality rate was significantly higher in the hypoalbuminemia group (24.0%) and marked hypoalbuminemia group (45%) compared with normal albumin group (8.3%; p < 0.01). Patients with lower baseline albumin levels have increased treatment-related morbidity and mortality, suggesting that pre-treatment serum albumin is an important independent prognostic marker.
老年和较差的体能状态导致急性髓系白血病 (AML) 患者的预后更差。低白蛋白血症是多种恶性肿瘤发病率和死亡率的负预测因子。我们评估了 756 例新诊断的 AML 患者的基线血清白蛋白水平与治疗相关并发症之间的关系，以及短期死亡率和总生存期 (OS)。我们进行了一项回顾性多中心研究，根据预处理血清白蛋白水平检查治疗相关并发症和 OS：正常白蛋白 ≥3.5 g/dl、显著低白蛋白血症 <2.5 g/dl 和低白蛋白血症 2.5-3.4 g/dl。在调整后的多变量分析中，在校正年龄、继发性 AML、性别和强化治疗后，较低的基线白蛋白与更高的≥3 级并发症数量独立相关。当将正常白蛋白与显著低白蛋白水平进行比较时，估计的并发症数量增加了 1.35 倍。基线白蛋白正常的患者 30 天死亡率为 4.8%，明显低于低白蛋白血症（16.5%）和显著低白蛋白血症（33.9%）患者（p<0.01）。同样，低白蛋白血症组（24.0%）和显著低白蛋白血症组（45%）的 60 天死亡率明显高于正常白蛋白血症组（8.3%）（p<0.01）。基线白蛋白水平较低的患者治疗相关发病率和死亡率增加，表明治疗前血清白蛋白是一个重要的独立预后标志物。
