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• W3017563477 abstract "Smoking is a well-established risk factor for cancers of the lung, head and neck; nasopharynx; upper digestive tract (esophagus, stomach, liver, pancreas); kidney; bladder; cervix; and for acute myeloid leukaemia (AML).1 Growing evidence also point towards a history of smoking, or being a current smoker, as a risk factor for decreased survival after diagnosis in a variety of cancers.2 In this issue, Kristensen et al. demonstrate a decreased overall survival for current smokers, or patients with a history of smoking, compared to never smokers in >1,000 patients who have been diagnosed with AML and received an intensive chemotherapy for remission induction. The authors thoroughly analysed a variety of clinical risk factors and were able to dissect the prognostic impact of smoking from that of alcohol consumption (often co-occurring), showing that alcohol consumption had no influence on prognosis. This finding adds to existing literature suggesting that smoking status is associated with a decreased outcome after AML diagnosis.3-5 So, is this puzzle now settled? Questions remain, since cytogenetic risk, which was found to be associated with smoking, was not included in this study, whereas performance status, which is associated with smoking in this study, was not included in other published studies. Overall, this study and others provide a strong indication that smoking not only influences the incidence of AML, but also the prognosis after AML diagnosis, even when patients are receiving uniform AML treatment. Due to the nature of retrospective correlative studies, it cannot be determined whether the inferior prognosis of patients with a smoking history is attributable to a more aggressive AML biology or to patient-related factors, such as an increased toxicity of AML treatment. Is it time to include smoking status in therapy stratification? Most likely not yet. Smoking status only had an influence on prognosis in females in this study, who had a better prognosis than males per se. In other words, smoking just ameliorated the gender advantage of females, and it is hard to imagine that a decision for or against an intensive therapy would be based on a risk factor that increases the risk of death by only 22%. It would, however, be a worthwhile task to integrate smoking status into established scoring systems (e.g., the AML score)7 to fine-tune information on benefits and risks of an intensive treatment for a given patient with AML." @default.
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• W3017563477 date "2020-04-27" @default.
• W3017563477 modified "2023-09-27" @default.
• W3017563477 title "Smoking and AML – another piece in the puzzle" @default.
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• W3017563477 doi "https://doi.org/10.1111/bjh.16683" @default.
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