Outcomes of Regimented Weight Monitoring on Morbidity and Mortality during AML Induction

• Published in: Blood 2023-11, Vol.142 (Supplement 1), p.5875-5875
• Main Authors: Shah, Anvay, Ghani, Nabil, Bradshaw, Danielle, Jillella, Anand, Kota, Vamsi K., Cortes, Jorge, Dalgetty, Mark, Branham, Zachery, Yerraguntla, Sandeep, Bryan, Locke Johnson, Keruakous, Amany R., Chauhan, Ayushi
• Format: Article
• Language: English
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood-2023-190979

Acute myeloid leukemia (AML) is characterized by the clonal expansion of myeloid blasts in the peripheral blood, bone marrow and other tissues. AML is a disease of elderly, with median age of 67 years at diagnosis. Current therapeutic options for elderly individuals with AML include intensive chemotherapy with a cytarabine and anthracycline backbone, hypomethylating agents (decitabine and azacytidine) alone or in combination with venetoclax. Targeted therapies, low dose cytarabine, investigational agents and supportive care with hydroxyurea and transfusions are other options. While monitoring daily weights has been well documented in APL due to concern for differentiation syndrome, little has been documented in AML. Monitoring daily weights can be a useful tool in maintaining patients' euvolemic status. This can help in appropriately resuscitating patients with AML as they are prone to sepsis due to their immunocompromised status. Also, it can help prevent fluid overload and prevent hypoxic respiratory failure. At our center over the last few years, we have standardized an approach to monitoring and maintaining the weights of our AML patients at or near their pre-admission level with IV fluids and diuresis, as needed. We report outcomes of regimented weight monitoring on morbidity and mortality during AML induction. METHOD We conducted a retrospective chart review of newly diagnosed AML patients treated at our center between January 2016 and May 2022. The cohort was divided into 2 groups; those treated prior to 2019 and those treated after. For each group, patients whose weights were monitored and maintained within 3 kilograms of admission weight were identified for comparison with those who were not. Induction regimens including 7 plus 3 with or without the addition of targeted therapies were reviewed. Patients who were ineligible for induction and those admitted directly to the ICU prior to the start of therapy were excluded from this study. We reviewed the records of 155 patients induced at our center; the mean age at diagnosis was 56 years (20-82). 74 (48%) of these 155 patients were females. Prior to 2019, 73 patients were induced; 68 of these patients did not have monitored weights. Of these 22 were ICU transfers (detailed in Table 2). The 5 remaining patients had weights monitored and none were transferred to the ICU. After January 1st 2019, weights were followed and euvolemia was maintained in 32 patients, of whom 3 (9.4%) were transferred to ICU.