Effect of geriatric nutrition risk index on prognosis in acute myeloid leukemia patients aged 65 and over

Introduction: Acute myeloid leukemia (AML) encompasses a heterogeneous group of aggressive blood cancers arising from the clonal expansion of malignant hematopoietic precursor cells in the bone marrow. Leukemic cells interfere with the production of normal blood cells, leading to weakness, infection, bleeding, and other symptoms and complications. AML is the most common acute leukemia in adults, accounting for approximately 80% of cases in this age group. Its incidence increases with age, with an average age of diagnosis of 68 years, and it accounts for about 1% of cancer-related deaths. Changes associated with normal aging increase nutritional risk for older adults. Aging is characterized by decreased organ system reserves and weakened homeostatic controls. Data from studies of acute hospital admissions in older adults indicate that up to 71% are at nutritional risk or malnourished. Malnutrition is associated with an increased risk of mortality. The aim of this study is to investigate the effect of the Geriatric Nutritional Risk Index (GNRI), an indicator of malnutrition, on prognosis in AML patients aged 65 and older. Materials and Methods: A total of 139 patients diagnosed with and treated for AML aged 65 and older were included in the study, conducted at İnönü University Turgut Özal Medical Center Hematology Clinic between January 2010 and December 2023. The variables examined included the patients age, gender, height, weight, body mass index (BMI), total protein, albumin, lactate dehydrogenase (LDH), aspartate aminotransferase (AST), alanine aminotransferase (ALT), blood urea nitrogen (BUN), creatinine, alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT), total bilirubin, direct bilirubin, white blood cell count (WBC), hemoglobin, hematocrit, neutrophil, monocyte, lymphocyte, platelet count, overall survival time, progression-free survival time, infection status, chemotherapy, and comorbidities. Results: In this study, 139 AML patients with an average age of 75.92 were analyzed. Of these patients, 39.6% were female, and 60.4% were male. The average height was 163.54 cm, weight was 70.08 kg, and BMI was 26.23 kg/m². The mean GNRI was 91.30. While 27.3% of the patients had no nutritional risk, 13.7% had high nutritional risk. Infections were detected in 97.8% of the patients, and 77.7% had comorbidities, the most common being hypertension (63%), coronary artery disease (39.8%), and benign prostatic hyperplasia (22.2%). Various treatment methods were applied, and 87.8% of the patients died. Positive correlations were found between GNRI and weight, BMI, protein, albumin, and hematocrit, while negative correlations were found with age, LDH, AST, bilirubin, and WBC. GNRI values were significantly lower in patients with COPD. Patients receiving intensive therapy had higher GNRI values compared to those receiving low-dose therapy. GNRI values were significantly lower in patients who died compared to those who survived. According to the ROC analysis, the GNRI cut-off value was determined to be 89, with 49.2% sensitivity and 88.2% specificity in predicting mortality. Discussion: The findings indicate that low GNRI is associated with poor prognosis, higher mortality rates, and organ dysfunction. GNRI showed positive correlations with weight, BMI, albumin, and hematocrit, and negative correlations with LDH, AST, bilirubin, and WBC. Albumin and total protein levels were strongly related to GNRI, supporting its reliability as an indicator of nutritional status. Additionally, infections were present in 97.8% of AML patients, but no significant difference was found between GNRI and the presence of infection. GNRI was found to be a strong predictor of mortality, and comorbidities like COPD negatively affected GNRI, worsening prognosis. GNRI was higher in patients receiving intensive treatment, suggesting a potential link between nutritional status and treatment response. Keywords: Elderly AML, AML, Geriatric Nutritional Risk Index (GNRI)