Serum Albumin as a Prognostic Factor in Acute Myeloid Leukemia

Introduction

In June 2024, Blood Science published a pivotal study led by Dr. Hui Wei from the Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College , investigating the prognostic significance of serum albumin levels in patients with acute myeloid leukemia (AML). AML is a highly aggressive hematological malignancy with outcomes influenced by various factors, including age, white blood cell count, and risk classification. Serum albumin, a critical component of blood, plays a role in maintaining colloid osmotic pressure and has been identified as a prognostic marker in various cancers, including AML.

This study aimed to evaluate the relationship between baseline serum albumin levels and patient outcomes in a homogeneously treated cohort of 591 newly diagnosed AML patients. The research highlights the importance of serum albumin as an independent prognostic factor for overall survival (OS) and relapse-free survival (RFS) in AML, particularly in patients receiving intermediate-dose cytarabine (ID-HAD) induction therapy.

Study Design and Patient Population

The study enrolled 591 patients aged 15 to 55 years with newly diagnosed AML. These patients were divided into two groups based on their baseline serum albumin levels: albumin-high (N = 299) and albumin-low (N = 292). The median baseline serum albumin level was 41.7 g/L, and participants were treated with either standard-dose cytarabine (SD-HAD) or ID-HAD combined with daunorubicin and omacetaxine mepesuccinate.

Key Findings

The study found that patients with lower baseline serum albumin levels were generally older, had higher white blood cell counts, and were more likely to have adverse genetic mutations such as NPM1 and RUNX1. Univariate analysis revealed that higher serum albumin levels were associated with better OS, RFS, and event-free survival (EFS). The cumulative incidence of relapse (CIR) was also lower in the albumin-high group compared to the albumin-low group.

Visual Data Analysis

This figure stratifies the prognostic impact of serum albumin based on the European LeukemiaNet (ELN) risk classification. In the intermediate-risk group (Panels E, F, G, H), the albumin-high group demonstrated significantly better OS (HR 0.585, p = 0.007), RFS (HR 0.571, p = 0.009), and EFS (HR 0.672, p = 0.025), with a lower CIR (HR 0.551, p = 0.002) compared to the albumin-low group. In contrast, the differences in survival outcomes were less pronounced in patients classified under favorable and adverse ELN risk categories (Panels A, B, C, D).

Figure. Overall survival, relapse-free survival, event-free survival, and cumulative incidence of relapse of patients with high or low baseline serum albumin levels inpatients undergoing SD-HAD (A–D) or ID-HAD (E–H) induction. HR = hazard ratio, ID-HAD = intermediate dose cytarabine combined with daunorubicin andomacetaxinemepesuccinate, SD-HAD = standard dose cytarabinecombined with daunorubicin andomacetaxinemepesuccinate.

（Blood Science 6(2):p e00189, April 2024. | DOI: 10.1097/BS9.0000000000000189）

Conclusion

This study by Dr. Hui Wei underscores the prognostic value of serum albumin levels in AML, particularly in patients undergoing ID-HAD induction therapy. The research highlights that lower baseline serum albumin levels are associated with worse outcomes, reflecting the inherent aggressiveness of leukemia. These findings suggest that serum albumin could be used as an additional tool for risk stratification in AML, especially for patients with intermediate ELN risk. Further studies are warranted to validate these findings and explore potential therapeutic strategies to improve outcomes for patients with low serum albumin levels.

Post Views: 1,154