High body mass index is an independent predictor of differentiation syndrome in patients with acute promyelocytic leukemia

Increased BMI has been correlated to an increased incidence of APL, but not to the occurrence of differentiation syndrome (DS) in APL. We consecutively treated 39 APL patients with ATRA and idarubicin (according to PETHEMA regimen). Median age was 26 years. Forty-one percent patients were classified as intermediate risk, and 59% as high risk according to Sanz's score. Thirty-three patients (85%) reached CR. Eleven of the 36 patients evaluable for DS (30.5%) developed this syndrome (severe in 7 cases, moderate in 4, and fatal in 3 cases) within a median of 12 days (range 3-23) of ATRA onset. Six of the 9 (66.6%) patients with BMI ≥ 30 developed DS vs. 5 of 27 (18.5%) with BMI < 30 (p = 0.012). Other predictors of DS in univariate analysis were: age ≥ 40 year (p = 0.033), baseline WBC ≥ 20 × 109/l (p = 0.003), and creatinine > 1.4 mg/dl (p = 0.009). In multivariate analysis, BMI ≥ 30 remained an independent predictor of DS in addition to baseline WBC ≥ 20 × 109/l. © 2009 Elsevier Ltd. All rights reserved.