N‐terminal pro‐brain natriuretic peptide is a prognostic marker for response to intensive chemotherapy, early death, and overall survival in acute myeloid leukemia

Abstract

AbstractPatient‐related factors are of prognostic importance in acute myeloid leukemia (AML). Likewise, cardiac disorders may limit the tolerance of intensive therapy. Little is known about the prognostic value of N‐terminal pro‐brain natriuretic peptide (NT‐proBNP). We analyzed NT‐proBNP levels at diagnosis in 312 AML patients (median age: 61 years; range 17–89 years) treated with 3 + 7‐based induction‐chemotherapy and consolidation with up to four cycles of intermediate or high‐dose ARA‐C. NT‐proBNP levels were elevated in 199 patients (63.8%), normal (0–125 pg/ml) in 113 (36.2%), and highly elevated (>2000 pg/ml) in 20 patients (6.4%). Median NT‐proBNP levels differed significantly among patients with complete remission (153.3 pg/ml), no remission (225.9 pg/ml), or early death (735.5 pg/ml) (p = .002). In multivariate analysis, NT‐proBNP, age, and the 2009 European LeukemiaNet (ELN‐2009) classification were independent predictors of outcome after induction chemotherapy. Overall survival (OS) differed significantly between patients with normal, moderately elevated, and highly elevated NT‐proBNP (p < .001). These differences were observed in all patients and in patients <60 years but not in those ≥60 years. In multivariate analysis, NT‐proBNP, age, and ELN‐2009 remained independent prognostic variables for OS (p < .01). Together, NT‐proBNP is an independent prognostic factor indicating the risk of induction failure, early death, and reduced OS in patients with AML.