4691 - High triglyceride is a major risk factor of DIC and differentiation syndrome in acute promyelocytic leukemia

Background

Acute promyelocytic leukemia (APL) is strongly related to obesity. APL patients have significantly higher body mass index (BMI) than other acute leukemia. In APL patients, BMI over 30 kg/m² is reported to be a risk factor of all trans retinoic acid (ATRA) induced differentiation syndrome (DS), and associated with inferior disease free survival (DFS) and overall survival (OS). We assessed the impact of obesity associated various factors on APL clinical course.

Methods

We retrospectively reviewed clinical records of the APL patients in our center since January 2008 to May 2019. We used Fisher’s exact test in univariate analysis, logistic regression in multivariate analysis, logrank test in survival analysis.

Results

51 patients were included in this study. The median age was 57 (range: 19-88), 24 females and 27 males. The median BMI was 23.1, 8 (15%) had BMI over 30 kg/m². All patients were administered ATRA only or ATRA plus anthracycline based chemotherapy. 35 (68%) developed DIC at diagnosis, 18 (35%) developed DS by ATRA administration.47 (92%) achieved complete remission, median suvival was 1304 days (1-6608).9 (17%) experienced relapse.8 (15%) were died by bleeding, another cancer, organ failure. BMI over 30 kg/m² was associated with high visceral and subcutaneous fat volume(P = 0.01, respectively). High triglyceride (TG) and LDL-cholesterol were independent of high BMI (P = 0.67, =0.54, respectively). In univariate and multivariate analysis, only high TG (over 150 mg/dl) was significantly associated with DIC (odds ratio (OR)= 10.6 (1.6-126.0), p = 0.004, OR = 11.6 (1.9-67.5), p = 0.006, respectively) and DS (OR = 7.31 (1.1-84.2), p = 0.02, OR = 7.7 (1.3-44.0), p = 0.02). BMI, TG, LDL, visceral or subcutaneous fat volume were not significantly affect with OS and DFS. DS onset or high white blood cell count were associated with inferior OS (P = 0.03) or PFS (P = 0.01).

Conclusions

High TG was a major risk factor of DIC and DS in APL treatment. It is possible that TG metabolic pathway will be linked to DIC and DS pathogenesis. Low fat diet or hyperlipidemia treatment may decrease DIC and DS progression.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The author.

Funding

Has not received any funding.

Disclosure

The author has declared no conflicts of interest.