Smoking status in acute myeloid leukemia is associated with worse overall survival and independent of prior non-hematopoietic malignancies, cytogenetic abnormalities, and WHO category.

Abstract

Acute myeloid leukemia (AML) is an aggressive hematopoietic malignancy with several patient and disease associated variables known to impact prognosis. Tobacco smoking is an environmental factor associated with a greater incidence of AML, but there have been limited studies that evaluated smoking toward overall survival. We retrospectively searched for AML cases and collected clinical and diagnostic data for each case. We also used an independent next-generation sequencing (NGS) dataset to assess for a distinct mutational signature associated with smoking. When stratified by smoking status, there was a greater number of males, patients > 60 years of age, and patients with > 2 comorbidities within the smoking category (P < 0.05). Survival analysis demonstrated decreased survival probability in the smokers, male smokers, smokers with 1 other comorbidity, and smokers without a prior history of non-hematopoietic malignancy (P < 0.05) as compared to non-smokers. Smoking was associated with a decrease in survival within the WHO categories of AML NOS (P = 0.035) and AML RGA (P = 0.002). Multivariate analysis showed that patients who were smokers had a greater HR as compared to non-smokers after adjusting for the other covariates. Our findings demonstrated that smoking was independently associated with decreased overall survival after adjusting for other potentially confounding factors. In addition, our results suggest that a mutational signature can be recognized using NGS data in a subset of AML patients who smoke.

View details for DOI 10.1016/j.humpath.2023.03.005

View details for PubMedID 36921727