The following article features coverage from the American Society of Clinical Oncology 2019 meeting. Click here to read more of Hematology Advisor’s conference coverage.

In patients with acute myeloid leukemia (AML), smoking history was found to be associated with worse survival and higher incidence of relapse, independent of age and performance status, according to data from a single center retrospective analysis presented at the 2019 American Society of Clinical Oncology (ASCO) Annual Meeting in Chicago, Illiinois.1

Previous research has shown that active smoking and history of smoking is a significant risk factor for the development of AML, increasing the relative risk by 40% and 25%, respectively.2 The influence of smoking history after AML diagnosis, however, is not as well studied and less understood. With this in mind, researchers sought to determine if smoking can also affect the biology of AML in addition to clinical outcomes for patients.

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“We reviewed all patients who were diagnosed at our center between June 2012 and June 2017,” said Mansour Alfayez, MD, MS, of the University of Texas MD Anderson Cancer Center in Houston. The research included patients with newly diagnosed AML with documented smoking history and available cytogenetics, molecular profiles, and clinical outcomes. Patients were placed in 2 groups: never smokers and ever smokers.

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The study included 561 patients: 272 ever smokers (median age, 69 years) and 289 never smokers (median age, 63 years). Across both groups, 53% of patients were male.

The researchers found an increase in the association between smoking and numerous risk factors, including age older than 60 years (P <.0001), complex karyotype (P <.0001), male sex (P <.0001), ASXL1-positive disease (P =.01), TP53-positive disease (P =.02), European LeukemiaNet (ELN) criteria (P =.002), secondary disease (P =.028), and dysplasia (P=.02). NPM1-positive disease (P =.04), FLT3-ITD (P =.027), and treatment intensity (P =.004) were found to have a negative decreased association with smoking.

Age was regarded as a significant cofounder, so the researchers controlled for age and found that the significances remained between smoking and poor ELN risk (P =.041), complex karyotype (P <.0001), dysplasia (P =.037), and GATA2 (P =.045) but were lost for FLT3-ITD (P =.073), IDH2 (P =.078), and PTPN11 (P =.07).

The researchers did not find an association between smoking and the number of mutations that a patient had.

Dr Alfayez noted that the study was limited by the fact that it was strictly a retrospective review and quantification of smoking history (amount and duration) was not available due to the way in which the institution captured this data.

“There very clearly seems to be continued evidence that smoking in patients with AML is associated with cytogenetic abnormalities, and this research adds new information about molecular abnormalities to the literature,” said Leslie R Ellis, MD, of Wake Forest University in Winston-Salem, North Carolina, during a discussion of Dr Alfayez and colleagues’ findings.


1. Alfayez M, Dalle IA, Richard-Carpentier GA, et al. Association of smoking with poor risk ELN 2017, cytogenetics/molecular profile, and survival outcomes in acute myeloid leukemia. Presented at: 2019 ASCO Annual Meeting; June 1, 2019; Chicago, IL. Abstract 7002.

2. Fircanis S, Merriam P, Khan N, Castillo JJ. The relation between cigarette smoking and risk of acute myeloid leukemia: an updated meta-analysis of epidemiological studies. Am J Hematol. 2014;89(8):E125-E132. doi:10.1002/ajh.23744