Prediction of early (4-week) mortality in acute myeloid leukemia with intensive chemotherapy

The progress with intensive chemotherapy and supportive care measures has improved survival in patients with newly diagnosed acute myeloid leukemia (AML). Given the recent development of effective low intensity therapies, an optimal decision on the therapy intensity may improve survival through the avoidance of early mortality. We reviewed the outcome of 3728 patients with newly diagnosed AML who received intensive chemotherapy between August 1980 and May 2020. Intensive chemotherapy was defined as a cumulative cytarabine dose ≥ 700 mg/m² during induction therapy. We divided the whole cohort into a training and validation group at a 3:1 ratio. The population was divided into a training (2790 patients) and a validation cohort (938 patients). The median age was 55 years (range, 15-99). Among them, 442 patients (12%) had core-binding factor AML. Binary logistic regression identified older age, worse performance status, hyperbilirubinemia, elevated creatinine, hyperuricemia, cytogenetic abnormalities other than CBF and -Y, and pneumonia as adverse prognostic factors for an early 4-week mortality. This risk classification for early mortality was verified in the validation cohort of patients. In the validation cohort of more recently treated patients from 2000 to 2017, the 4-week mortality rates with intensive chemotherapy were 2%, 14%, and 50% in the low-, high-, and very high-risk group, respectively. The mortality rates with low intensity therapies were 3%, 9%, and 20%, respectively. The risk classification guides treatment intensity by the assessment of age, frailty, organ dysfunction, cytogenetic abnormality, and infection to avoid early mortality.     

Acute myeloid leukemia: current progress and future directions

Progress in the understanding of the biology and therapy of acute myeloid leukemia (AML) is occurring rapidly. Since 2017, nine agents have been approved for various indications in AML. These included several targeted therapies like venetoclax, FLT3 inhibitors, IDH inhibitors, and others. The management of AML is complicated, highlighting the need for expertise in order to deliver optimal therapy and achieve optimal outcomes. The multiple subentities in AML require very different therapies. In this review, we summarize the important pathophysiologies driving AML, review current therapies in standard practice, and address present and future research directions.Subject terms: Prognosis, Health services     

The Association Between Index of Nutritional Quality (INQ) and Glioma and Evaluation of Nutrient Intakes of These Patients: A Case-Control Study

Introduction: Glioma is the most common adult brain tumors. Dietary factors may play a role in the etiology of glioma. The Index of Nutritional Quality (INQ) provides a general overview for the nutrient content of a food or a diet. This study aimed to investigate the association between INQ and glioma and nutrient intakes. Material and methods: This study was included 128 patients and 256 controls. Dietary intakes of the subjects were evaluated by a food frequency questionnaire (FFQ) and FFQ-derived dietary data were used to calculate INQ scores. Logistic regression was used to calculate the odds ratios and 95% confidence intervals. Results: Cases had higher intake of total fat, saturated fatty acid (SFA), meats, hydrogenated oils and controls had higher intake of monounsaturated fatty acid, polyunsaturated fatty acid, calcium, dairy, fruits, and nuts. Only the INQ of vitamin C, vitamin E, calcium, and fiber are higher in controls. An inverse association was observed between glioma and INQ of calcium, vitamin E, vitamin C, and fiber. Conclusion: The results of this study propose a healthy diet such as high intake of vitamins C and E, calcium, fiber, food groups like fruits and vegetables, and low-fat milk and nuts; and low consumption of total fat, SFA, and red meat may be protective against glioma.