Background

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.

Aim

The aim of this study is to describe the effect of osteoporosis/osteopenia on the survival of patients with AML/ high risk MDS

Methods

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.

Results

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.

Table 1
GroupNumber failedNumber censoredMeanStd 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 
GroupNumber failedNumber censoredMeanStd 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 
View Large
Table 2
GroupMedian TimeLower 95%Upper 95%25% Failures75% 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 
GroupMedian TimeLower 95%Upper 95%25% Failures75% 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 
View Large
Table 3
TestChiSquareDFProb>ChiSq
Log-Rank 1.9128 2 0.384 
Wilcoxon 1.1936 2 0.550 
TestChiSquareDFProb>ChiSq
Log-Rank 1.9128 2 0.384 
Wilcoxon 1.1936 2 0.550 
View Large
graphic
View largeDownload slide
Conclusions

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.

Disclosures:

No relevant conflicts of interest to declare.

Topics:
bone mineral density, leukemia, myelocytic, acute, myelodysplastic syndrome, osteoporosis, osteopenia, bisphosphonates, compression fractures, kaplan-meier survival curve, survival curve, blast cells

Author notes

*

Asterisk with author names denotes non-ASH members.

© 2013 by The American Society of Hematology
2013
Sign in via your Institution