Abstract
Acute myeloid leukemia results from clonal proliferation of myeloid precursors, resulting in accumulation of leukemic blasts in the bone marrow. The effect of leukemic blasts in the bone have not been well studied. It is hypothesized that leukemic blasts may affect the osteoblast and osteoclast balance.
The aim of this study is to describe the effect of osteoporosis/osteopenia on the survival of patients with AML/ high risk MDS
A retrospective study of all AML and high-risk MDS patients treated at Akron General Medical Center, Ohio during 2001-2012. Following IRB approval, patients' charts were reviewed for information on demographics, cytogenetics, and treatment. Patients were classified into low risk, intermediate risk and high risk MDS based on WHO criteria. Charts were reviewed for a diagnosis of osteoporosis/osteopenia. Overall survival rates were determined by Kaplan-Meier survival analysis. Patients were classified into osteopenia/osteoporosis based on bone density scans. An additional three patients were identified with osteopenia on the basis of lumbar X rays and one patient was diagnosed with osteoporosis on the basis of typical compression fracture for osteoporosis.
During the study period, 187 patients were identified with AML/high risk MDS. A total of 31 patients were found to have osteopenia/osteoporosis based on radiological findings. Eight patients had osteoporosis and 24 patients had osteopenia. A survival analysis was performed on the study population based on bone mineral density. Group one (osteoporosis) included eight patients; group two (osteopenia) included 23 patients and group three (no radiological evidence of osteoporosis/osteopenia) included 156 patients. Results are depicted in the survival curve below.
| Group | Number failed | Number censored | Mean | Std Error |
|---|---|---|---|---|
| 1 | 8 | 0 | 40.625 | 21.3742 |
| 2 | 17 | 6 | 113.862 | 37.558 |
| 3 | 123 | 33 | 105.084 | 14.2582 |
| Combined | 148 | 39 | 102.268 | 12.5375 |
| Group | Number failed | Number censored | Mean | Std Error |
|---|---|---|---|---|
| 1 | 8 | 0 | 40.625 | 21.3742 |
| 2 | 17 | 6 | 113.862 | 37.558 |
| 3 | 123 | 33 | 105.084 | 14.2582 |
| Combined | 148 | 39 | 102.268 | 12.5375 |
| Group | Median Time | Lower 95% | Upper 95% | 25% Failures | 75% Failures |
|---|---|---|---|---|---|
| 1 | 20 | 1 | 53 | 9.5 | 40 |
| 2 | 52 | 7 | 119 | 7 | 119 |
| 3 | 40 | 21 | 61 | 6 | 136 |
| Combined | 40 | 23 | 58 | 6 | 136 |
| Group | Median Time | Lower 95% | Upper 95% | 25% Failures | 75% Failures |
|---|---|---|---|---|---|
| 1 | 20 | 1 | 53 | 9.5 | 40 |
| 2 | 52 | 7 | 119 | 7 | 119 |
| 3 | 40 | 21 | 61 | 6 | 136 |
| Combined | 40 | 23 | 58 | 6 | 136 |
| Test | ChiSquare | DF | Prob>ChiSq |
|---|---|---|---|
| Log-Rank | 1.9128 | 2 | 0.384 |
| Wilcoxon | 1.1936 | 2 | 0.550 |
| Test | ChiSquare | DF | Prob>ChiSq |
|---|---|---|---|
| Log-Rank | 1.9128 | 2 | 0.384 |
| Wilcoxon | 1.1936 | 2 | 0.550 |
Bone mineral density remains an unidentified factor in patient's survival, suffering from AML/ High risk MDS. It appears that patients with normal bone density may live longer than patients with osteopenia/osteoporosis, but this is not confirmed here statistically. Future studies with a larger patient sample may be helpful in further exploring this aspect and the role of bisphosphonates in patients with AML/high risk MDS.
No relevant conflicts of interest to declare.
