Inflammatory biomarkers, geriatric assessment, and treatment outcomes in acute myeloid leukemia

Objectives: To investigate changes in inflammatory biomarkers during induction therapy for older adults with acute myeloid leukemia (AML) and their associations with geriatric assessment (GA) measures and outcomes. Methods: This was a single institution ancillary study to a prospective observational study (N = 20 consecutive adults aged >= 60 with newly diagnosed AML who received induction chemotherapy). Biomarkers (Interleukin6 [IL-61. IL-6 soluble receptor [IL-6 sR], tumor necrosis Factor alpha [TNF alpha], TNF alpha soluble receptor 1 [TNF alpha sR1], interleukin-3 [IL-3], C-reactive protein [CRP]) were collected at start of induction, weekly for three weeks, and post-induction and were compared over time using paired t-tests. GA was administered at baseline and post-induction, and correlated with biomarker levels using Spearman correlations. Survival was estimated using Kaplan-Meier and compared by categorized biomarker level using Wilcoxon tests. Results: Biomarker levels were stable during induction, except for CRP and IL-6 sit Declines in objectively measured physical function [Short Physical Performance Battery (SPPB); r = 0.71, p < 0.01] and increases in self-reported limitation in instrumental activities of daily living (r = 0.81, p < 0.01) were correlated with increased TNF alpha sR1. Declines in SPPB were correlated with increased CRP (r = -0.73, p < 0.01). Improvement in depression was correlated with increased IL-6 sR (r = -0.59 p = 0.02). Survival was shorter in those with baseline TNF alpha or CRP levels above the median (6.1 vs. 40.2 months and 5.5 vs. 27.6 months respectively, p = 0.04 for both). Conclusion: Among older adults with AML the relationships between TNF alpha sR1, CRP, and IL-6 sR with change in physical and emotional health during treatment warrants further investigation. (C) 2019 Elsevier Ltd. All rights reserved.