Increased BMI correlates with higher risk of disease relapse and differentiation syndrome in patients with acute promyelocytic leukemia treated with the AIDA protocols

We investigated whether body mass index (BMI) correlates with distinct outcomes in newly diagnosed APL. The study population included 144 patients with newly diagnosed and genetically confirmed APL consecutively treated at a single institution. All patients received All-trans retinoic acid and idarubicin according to the GIMEMA protocols AIDA-0493 and AIDA-2000. Outcome estimates according to the BMI were carried out together with multivariable analysis for the risk of relapse and differentiation syndrome (DS). Fifty-four (37.5%) were under/normal weight (BMI<25) while 90 (62.5%) patients were overweight/obese (BMI≥25). An increased BMI was associated with older age (p=<0.0001) and male gender (p=0.02). BMI was the most powerful predictor of DS in multivariable analysis (OR = 7.24; 95% CI: 1.50, 39.95; p=0.014). After a median follow-up of 6 years, the estimated cumulative incidence of relapse (CIR) at 5 years was 31.6% (95% CI: 22.7%,43.8%) in overweight/obese and 11.2% (95% CI: 5.3%,23.8%) in underweight/normal weight patients (p=0.029). Multivariable analysis showed that BMI was an independent predictor of relapse (HR = 2.45, 95% CI 1.00, 5.99, in overweight/obese vs under/normal weight patients, p=0.049). An increased BMI at diagnosis is associated with a higher risk of developing DS and disease relapse in APL patients treated with AIDA protocols.