The Prognostic Value of C-Reactive Protein and Albumin in Newly Diagnosed Patients with AML
Abstract
Background: Acute-phase reactant proteins, particularly C-reactive protein (CRP), play a critical role in the initiation, progression, and recurrence of cancers such as acute myeloid leukemia.
Materials and Methods: We retrospectively analyzed 127 newly diagnosed non-M3 acute myeloblastic leukemia (non-M3 AML) patients. We investigated pre-treatment levels of C-reactive protein (CRP), Albumin, and C-reactive protein to albumin ratio (CAR) with cytogenetics, response to induction therapy, recurrence, and overall survival.
Results: We did not find any relationship between levels of CRP, Albumin, and C-reactive protein to albumin ratio (CAR) with complete remission rate, recurrence, and risk categorization of patients (P > 0.05).
3-and 5- year overall survival was 40.8% (with a standard error of 4.7%) and 30.1% (standard error: 5.3%), respectively. In addition, 3-year and 5-year event-free survival was 31.3% (standard error = 4.4%) and 25.8% (standard error = 4.8%), respectively. The only prognostic factor was allogenic stem cell transplantation (SCT).
Conclusion: Although CRP, Albumin, and CAR serve as convenient prognostic markers, they were not predictive of overall survival (OS) and event-free survival (EFS) in AML patients. Further studies are needed in the future to confirm or refute our results.
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6. Yang S, Zhao K, Ding X, et al. Prognostic significance of hematological markers for patients with nasopharyngeal carcinoma: a meta-analysis. J Cancer. 2019; 10(11): 2568-2577.
7. Haruki K, Shiba H, Horiuchi T, et al. Impact of the C- reactive protein to albumin ratio on long-term outcomes after hepatic resection for colorectal liver metastasis. Am J Surg. 2017; 214(4): 752- 756.
8. Skar ET, Wendelbo Q, Reikvam H. The prognostic impact of C- reactive protein and albumin in patients diagnosed with acute myeloid leukemia. EJHaem. 2024: 5(6):1223-1235.
9. Döhner H, Wei AH , Appelbaum FR, et al. Diagnosis and management of AML in adults: 2022 recommendations from an international expert panel on behalf of the ELN. Blood. 2022; 140 (12): 1345–1377.
10. Zhang Y, Xiao G. Prognostic significance of the ratio of fibrinogen and albumin in human malignancies: a meta-analysis. Cancer Manag Res. 2019; 11: 3381- 3393.
11. Li N, Tian GW, Wang Y, et al. Prognostic role of the pretreatment C- reactive protein/ albumin in solid cancers: A meta-analysis. Sci Rep. 2017;7: 41298.
12. Kristinsson SY, Bjorkholm M, Hultcrantz M, et al. Chronic immune stimulation might act as a trigger for the development of acute myeloid leukemia or myelodysplastic syndromes. J Clin Oncol. 2011; 29(21): 2897- 2903.
13. Wang N, Desai A, Ge B, et al. Prognostic value of hypoalbuminemia at diagnosis in de novo non-M3 acute myeloid leukemia. Leuk Lymphoma. 2020; 61(3): 641-649.
14. Shah A, Fox A, Bradshaw D, et al. Serum albumin as a prognostic marker for overall survival in acute myeloid leukemia. Preprints. Org. (www. Preprinting. Org). 2024 Jun 11: 10.20944
15. Stelmach P, Trumpp A. Leukemia stem cells and therapy resistance in acute myeloid leukemia. Haematologica. 2023; 108(2): 353-366.
16. Lachowiez CA, Long N, Saultz J, et al. Comparison and validation of the 2022 European Leukemia Net guidelines in acute myeloid leukemia. Blood Adv. 2023; 7(9): 1899-1909.
17. Leotta S, Condorelli A, Sciortino R, et al. Prevention and treatment of acute myeloid leukemia relapse after hematopoietic stem cell transplantation: The state of the art and future perspectives. J Clin Med. 2022; 11(1): 253.
18. Chan DSM, Bandera EV, Greenwood DC, et al. Circulating C-reactive protein and breast cancer risk- systemic literature review and meta-analysis of prospective cohort study. Cancer Epidemiol Biomarkers Prev. 2015; 24(10): 1439-49.
19. Lacourt TE, Kavelaars A, Galloway- Pena JR, et al. Association of inflammation with symptom burden in patients with acute myeloid leukemia. Psychoneuroendocrinology. 2018; 89: 203- 208.
20. Blinder S, Luciano M, Horejs- Hoeck J. The cytokine network in acute myeloid leukemia (AML): A focus on pro- and anti-inflammatory mediators. Cytokine Growth Factor Rev. 2018;43: 8- 15.
21. Loh KP, Tooze JA, Nicklas BJ, et al. Inflammatory biomarkers, geriatric assessment, and treatment outcomes in acute myeloid leukemia. J Geriatric Oncol. 2020; 11(3): 410-416.
22. Doucette K, Percival ME, Williams L, et al. Hypoalbuminemia as a prognostic biomarker for higher mortality and treatment complications in acute myeloid leukemia. Hematol Oncol. 2021; 39(5):697- 706.
23. Filliatre- Clement L, Broseus J, Muller M, et al. Serum albumin or body mass index: Which prognostic factor for survival in patients with acute myeloid leukemia. Hematol Oncol. 2019; 37(1): 80-84.
24. Liu M, Wang L. Prognostic significance of preoperative serum albumin, albumin-to-globulin ratio, and prognostic nutritional index for patients with glioma: A meta-analysis. Medicine (Baltimore). 2020; 99 (27): e20927.
25. Seebacher V, Grimm C, Reinthaller A, et al. The value of serum albumin as a novel independent marker for prognosis in patients with endothelial cancer. Eur J Obstet Gynecol Reprod Biol. 2013; 171 (1): 101-6.
26. Kharfan-Dabaja MA, Chavez JC, Yu D, et al. Severe hypoalbuminemia at day 90 predicts worse non-relapse mortality and overall survival after allogeneic hematopoietic stem cell transplantation for acute myelogenous leukemia and myelodysplastic syndrome. Biol Blood Marrow Transplant. 2011; 17(3): 384- 93.
27. Yu ST, Zhou Z, Cai Q, et al. Prognostic value of the C- reactive protein/ albumin ratio in patients with laryngeal squamous cell carcinoma. Onco Targets Ther. 2017: 10: 879- 884.
28. Xu HJ, Ma Y, Deng F, et al. The prognostic value of C- reactive protein/ albumin ratio in human malignancies: an updated meta-analysis. Onco Targets Ther. 2017: 10: 3059-3070.
29. Senjo H, Onozawa M, Hidaka D, et al. High CRP- albumin ratio predicts poor prognosis in transplant ineligible elderly patients with newly diagnosed acute myeloid leukemia. Sci Rep. 2022; 12(1):8885.
30. Dou L, Shi M, Song J, et al. The prognostic significance of C- reactive protein to albumin ratio in newly diagnosed acute myeloid leukemia patients. Cancer Manag Res. 2022: 14: 303- 316.
31. Heini AD, Hugo R, Berger MD, et al. Simple acute phase protein score to predict long-term survival in patients with acute myeloid leukemia. Hematol Oncol.2020; 38(1): 74-81.
32. Li B, Deng H, Lei B, et al. The prognostic value of fibrinogen to albumin ratio in malignant tumor patients: a meta-analysis. Front Oncol. 2022; 12: 985377.
33. Artz AS, Logan B, Zhu X, et al. The prognostic value of serum C- reactive protein, ferritin, and albumin prior to allogeneic transplantation for acute myeloid leukemia and myelodysplastic syndromes. Haematologica. 2016; 101 (11): 1426- 1433.
2. Wang CS, Sun CF. C- reactive protein and malignancy: clinic- pathological association and therapeutic implication. Chang Gung Med J. 2009; 32(5): 471- 82.
3. Craver BM, Alaoui KE, Scherber RM, et al. The critical role of inflammation in the pathogenesis and progression of myeloid malignancies. Cancers (Basel). 2018; 10(4):104.
4. Cai Y, Zhao Y, Dai Q, et al. Prognostic value of the albumin- globulin ratio and albumin- globulin score in patients with multiple myeloma. J Int Med Res. 2021;49(3): :300060521997736.
5. Levitt DG, Levitt MD. Human serum albumin homeostasis: a new look at the role of synthesis, catabolism, renal and gastrointestinal excretion, and the clinical value of serum albumin measurements. Int J Gen Med. 2016: 9: 229-55.
6. Yang S, Zhao K, Ding X, et al. Prognostic significance of hematological markers for patients with nasopharyngeal carcinoma: a meta-analysis. J Cancer. 2019; 10(11): 2568-2577.
7. Haruki K, Shiba H, Horiuchi T, et al. Impact of the C- reactive protein to albumin ratio on long-term outcomes after hepatic resection for colorectal liver metastasis. Am J Surg. 2017; 214(4): 752- 756.
8. Skar ET, Wendelbo Q, Reikvam H. The prognostic impact of C- reactive protein and albumin in patients diagnosed with acute myeloid leukemia. EJHaem. 2024: 5(6):1223-1235.
9. Döhner H, Wei AH , Appelbaum FR, et al. Diagnosis and management of AML in adults: 2022 recommendations from an international expert panel on behalf of the ELN. Blood. 2022; 140 (12): 1345–1377.
10. Zhang Y, Xiao G. Prognostic significance of the ratio of fibrinogen and albumin in human malignancies: a meta-analysis. Cancer Manag Res. 2019; 11: 3381- 3393.
11. Li N, Tian GW, Wang Y, et al. Prognostic role of the pretreatment C- reactive protein/ albumin in solid cancers: A meta-analysis. Sci Rep. 2017;7: 41298.
12. Kristinsson SY, Bjorkholm M, Hultcrantz M, et al. Chronic immune stimulation might act as a trigger for the development of acute myeloid leukemia or myelodysplastic syndromes. J Clin Oncol. 2011; 29(21): 2897- 2903.
13. Wang N, Desai A, Ge B, et al. Prognostic value of hypoalbuminemia at diagnosis in de novo non-M3 acute myeloid leukemia. Leuk Lymphoma. 2020; 61(3): 641-649.
14. Shah A, Fox A, Bradshaw D, et al. Serum albumin as a prognostic marker for overall survival in acute myeloid leukemia. Preprints. Org. (www. Preprinting. Org). 2024 Jun 11: 10.20944
15. Stelmach P, Trumpp A. Leukemia stem cells and therapy resistance in acute myeloid leukemia. Haematologica. 2023; 108(2): 353-366.
16. Lachowiez CA, Long N, Saultz J, et al. Comparison and validation of the 2022 European Leukemia Net guidelines in acute myeloid leukemia. Blood Adv. 2023; 7(9): 1899-1909.
17. Leotta S, Condorelli A, Sciortino R, et al. Prevention and treatment of acute myeloid leukemia relapse after hematopoietic stem cell transplantation: The state of the art and future perspectives. J Clin Med. 2022; 11(1): 253.
18. Chan DSM, Bandera EV, Greenwood DC, et al. Circulating C-reactive protein and breast cancer risk- systemic literature review and meta-analysis of prospective cohort study. Cancer Epidemiol Biomarkers Prev. 2015; 24(10): 1439-49.
19. Lacourt TE, Kavelaars A, Galloway- Pena JR, et al. Association of inflammation with symptom burden in patients with acute myeloid leukemia. Psychoneuroendocrinology. 2018; 89: 203- 208.
20. Blinder S, Luciano M, Horejs- Hoeck J. The cytokine network in acute myeloid leukemia (AML): A focus on pro- and anti-inflammatory mediators. Cytokine Growth Factor Rev. 2018;43: 8- 15.
21. Loh KP, Tooze JA, Nicklas BJ, et al. Inflammatory biomarkers, geriatric assessment, and treatment outcomes in acute myeloid leukemia. J Geriatric Oncol. 2020; 11(3): 410-416.
22. Doucette K, Percival ME, Williams L, et al. Hypoalbuminemia as a prognostic biomarker for higher mortality and treatment complications in acute myeloid leukemia. Hematol Oncol. 2021; 39(5):697- 706.
23. Filliatre- Clement L, Broseus J, Muller M, et al. Serum albumin or body mass index: Which prognostic factor for survival in patients with acute myeloid leukemia. Hematol Oncol. 2019; 37(1): 80-84.
24. Liu M, Wang L. Prognostic significance of preoperative serum albumin, albumin-to-globulin ratio, and prognostic nutritional index for patients with glioma: A meta-analysis. Medicine (Baltimore). 2020; 99 (27): e20927.
25. Seebacher V, Grimm C, Reinthaller A, et al. The value of serum albumin as a novel independent marker for prognosis in patients with endothelial cancer. Eur J Obstet Gynecol Reprod Biol. 2013; 171 (1): 101-6.
26. Kharfan-Dabaja MA, Chavez JC, Yu D, et al. Severe hypoalbuminemia at day 90 predicts worse non-relapse mortality and overall survival after allogeneic hematopoietic stem cell transplantation for acute myelogenous leukemia and myelodysplastic syndrome. Biol Blood Marrow Transplant. 2011; 17(3): 384- 93.
27. Yu ST, Zhou Z, Cai Q, et al. Prognostic value of the C- reactive protein/ albumin ratio in patients with laryngeal squamous cell carcinoma. Onco Targets Ther. 2017: 10: 879- 884.
28. Xu HJ, Ma Y, Deng F, et al. The prognostic value of C- reactive protein/ albumin ratio in human malignancies: an updated meta-analysis. Onco Targets Ther. 2017: 10: 3059-3070.
29. Senjo H, Onozawa M, Hidaka D, et al. High CRP- albumin ratio predicts poor prognosis in transplant ineligible elderly patients with newly diagnosed acute myeloid leukemia. Sci Rep. 2022; 12(1):8885.
30. Dou L, Shi M, Song J, et al. The prognostic significance of C- reactive protein to albumin ratio in newly diagnosed acute myeloid leukemia patients. Cancer Manag Res. 2022: 14: 303- 316.
31. Heini AD, Hugo R, Berger MD, et al. Simple acute phase protein score to predict long-term survival in patients with acute myeloid leukemia. Hematol Oncol.2020; 38(1): 74-81.
32. Li B, Deng H, Lei B, et al. The prognostic value of fibrinogen to albumin ratio in malignant tumor patients: a meta-analysis. Front Oncol. 2022; 12: 985377.
33. Artz AS, Logan B, Zhu X, et al. The prognostic value of serum C- reactive protein, ferritin, and albumin prior to allogeneic transplantation for acute myeloid leukemia and myelodysplastic syndromes. Haematologica. 2016; 101 (11): 1426- 1433.
| Files | ||
| Issue | Vol 19 No 2 (2025) | |
| Section | Original Article(s) | |
| Keywords | ||
| Non-M3 AML; Prognostic value; CAR | ||
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How to Cite
1.
Namdari N, Haghpanah S, Ataie E, Ghanbarian F, Mokhtari M, Amini M. The Prognostic Value of C-Reactive Protein and Albumin in Newly Diagnosed Patients with AML. Int J Hematol Oncol Stem Cell Res. 2025;19(2):101-108.
