Obesity in adult acute myeloid leukemia is not associated with inferior response or survival even when dose capping anthracyclines: An ECOG-ACRIN analysis

James M. Foran, Zhuoxin Sun, Catherine Lai, Hugo F. Fernandez, Larry D. Cripe, Rhett P. Ketterling, Janis Racevskis, Selina M. Luger, Elisabeth Paietta, Hillard M. Lazarus, Yanming Zhang, John M. Bennett, Ross L. Levine, Jacob M. Rowe, Mark R. Litzow, Martin S. Tallman

Research output: Contribution to journalArticlepeer-review


Background: Obesity (body mass index [BMI] ≥30 kg/m2) is an important epidemiological risk factor for developing acute myeloid leukemia (AML). Therefore, the authors studied the association of obesity with clinical and genetic phenotype and its impact on outcome in adults with AML. Methods: The authors analyzed BMI in 1088 adults who were receiving intensive remission induction and consolidation therapy in two prospective, randomized therapeutic clinical trials of the Eastern Cooperative Oncology Group-American College of Radiology Imaging Network: E1900 (ClinicalTrials.gov identifier NCT00049517; patients younger than 60 years) and E3999 (ClinicalTrials.gov identifier NCT00046930; patients aged 60 years or older). Results: Obesity was prevalent at diagnosis (33%) and, compared with nonobesity, was associated with intermediate-risk cytogenetics group (p =.008), poorer performance status (p =.01), and a trend toward older age (p =.06). Obesity was not associated with somatic mutations among a selected 18-gene panel that was tested in a subset of younger patients. Obesity was not associated with clinical outcome (including complete remission, early death, or overall survival), and the authors did not identify any patient subgroup that had inferior outcomes based on BMI. Obese patients were significantly more likely to receive <90% of the intended daunorubicin dose despite protocol specification, particularly in the E1900 high-dose (90 mg/m2) daunorubicin arm (p =.002); however, this did not correlate with inferior overall survival on multivariate analysis (hazard ratio, 1.39; 95% confidence interval, 0.90–2.13; p =.14). Conclusions: Obesity is associated with unique clinical and disease-related phenotypic features in AML and may influence physician treatment decisions regarding daunorubicin dosing. However, the current study demonstrates that obesity is not a factor in survival, and strict adherence to body surface area-based dosing is not necessary because dose adjustments do not affect outcomes.

Original languageEnglish (US)
Pages (from-to)2479-2490
Number of pages12
Issue number16
StatePublished - Aug 15 2023


  • acute myeloid leukemia (AML)
  • body mass index (BMI)
  • daunorubicin
  • dose adjustment
  • epidemiology
  • obesity

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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