Yoğun İndüksiyon Tedavisi Alan Yeni Tanı Akut Miyeloid Lösemi Hastalarında C-Reaktif Protein/Albümin Oranının (CAR) Prognostik Değeri: Tek Merkezli Retrospektif Kohort Çalışması

Öz

Amaç: İnflamasyon, akut miyeloid lösemi (AML) biyolojisinde önemli bir rol oynar ve klinik sonuçları etkileyebilir. C-reaktif protein/albümin oranı (CAR), sistemik inflamasyonun basit bir göstergesidir. Bu çalışmada, yoğun tedavi uygulanan AML hastalarında başlangıç CAR değerinin prognostik değeri araştırıldı. Gereç ve Yöntem: Kasım 2022–Mayıs 2025 tarihleri arasında Ankara Etlik Şehir Hastanesinde yeni tanı AML alan, yoğun indüksiyon tedavisine uygun olan ve bu tedaviyi alan 114 erişkin hasta retrospektif olarak değerlendirildi. CAR, tanı anındaki CRP değerinin (mg/L) serum albümin değerine (g/L) bölünmesiyle hesaplandı. Hastalar kohort medyanına göre düşük ve yüksek CAR gruplarına ayrıldı. Genel sağkalım (GS) ve progresyonsuz sağkalım (PFS) Kaplan–Meier yöntemi ile tahmin edildi ve log-rank testi ile karşılaştırıldı. Cox regresyon analizi genel sağkalım için gerçekleştirildi. Bulgular: Ortanca yaş 49 yıl olup hastaların 62’si (%54,4) erkekti. GS, düşük CAR grubunda yüksek CAR grubuna göre anlamlı olarak daha uzundu; tahmini 2 yıllık GS oranları sırasıyla %78 ve %55,6 idi (p=0,008). Benzer şekilde, progresyonsuz sağkalım (PFS) düşük CAR grubunda yüksek CAR grubuna göre anlamlı olarak daha uzundu; tahmini 2 yıllık PFS oranları sırasıyla %65,9 ve %44,1 idi (p=0,016). ELN orta riskli hastalarda, 2 yıllık GS düşük CAR grubunda yüksek CAR grubuna göre anlamlı olarak daha yüksekti (%88,2’ye karşı %50,0; p=0,021). Allojeneik kök hücre nakli uygulanmayan hastalarda yüksek CAR daha kötü GS ile ilişkiliydi (p=0,042). ELN iyi risk dışındaki hastalarda yapılan çok değişkenli analizde, yüksek CAR [HR 4,63 (1,61–13,30); p=0,004] ve allo-HKHN uygulanmaması [HR 6,39 (2,19–18,67); p=0,001] daha kötü GS ile bağımsız olarak ilişkiliydi. Sonuç: Yeni tanı AML hastalarında CAR, sağkalımı öngörmede kullanılabilecek basit ve erişilebilir bir biyobelirteçtir. Genetik risk sınıflaması prognostik değerlendirmenin temelini oluşturmakla birlikte, özellikle orta risk AML grubunda CAR bu sınıflamaya ek prognostik bilgi sağlayabilir.

Anahtar Kelimeler

• Albümin
• C-Reaktif protein
• Lösemi

Destekleyen Kurum

Çalışma için finansal destek alınmamıştır.

Proje Numarası

AEŞH-BADEK-2026-587

Etik Beyan

Çalışma için 29/07/2026 tarihinde Ankara Etlik Şehir Hastanesi Bilimsel Araştırmalar Değerlendirme ve Etik Kurulu’ndan onay alınmıştır. Karar no: AEŞH-BADEK-2026-587

C-Reactive Protein-to-Albumin Ratio (CAR) as a Prognostic Biomarker in Newly Diagnosed Acute Myeloid Leukemia Treated with Intensive Induction Therapy: A Single-Center Retrospective Cohort Study

Öz

Objective: Inflammation plays an important role in acute myeloid leukemia (AML) biology and may influence clinical outcomes. The C-reactive protein-to-albumin ratio (CAR) is a simple marker of systemic inflammation. We evaluated the prognostic value of baseline CAR in patients with AML treated with intensive therapy. Materials and Methods: We retrospectively analyzed 114 adults with newly diagnosed AML who were eligible for intensive induction therapy and received it (7+3 idarubicin and cytarabine regimen) at Ankara Etlik City Hospital between November 2022 and May 2025. CAR was calculated at diagnosis as CRP (mg/L) divided by serum albumin (g/L). Patients were stratified into low- and high-CAR groups according to the cohort median. Overall survival (OS) and progression-free survival (PFS) were estimated by the Kaplan–Meier method and compared with the log-rank test. Cox regression analysis was performed for OS. Results: The median age was 49 years, and 62 patients (54.4%) were male. OS was significantly longer in the low-CAR group than in the high-CAR group, with estimated 2-year OS rates of 78.0% and 55.6%, respectively (p=0.008). Similarly, PFS was significantly longer in the low-CAR group than in the high-CAR group, with estimated 2-year PFS rates of 65.9% and 44.1%, respectively (p=0.016). In ELN intermediate-risk patients, 2-year OS was significantly higher in the low-CAR group than in the high-CAR group (88.2% vs. 50.0%; p=0.021). Among non-transplanted patients, high CAR was associated with inferior OS (p=0.042). In multivariable analysis of ELN non-favorable-risk patients, high CAR [HR 4.63 (1.61–13.30); p=0.004] and absence of allo-HSCT [HR 6.39 (2.19–18.67); p=0.001] were independently associated with inferior OS. Conclusion: In newly diagnosed AML patients, CAR is a simple and accessible biomarker that may help predict survival. Although genetic risk stratification remains the cornerstone of prognostic assessment, CAR may provide additional prognostic information, particularly in patients with intermediate-risk AML.

Anahtar Kelimeler

• Albumin
• Albumin
• C-Reactive Protein
• Leukemia

Destekleyen Kurum

There are no financial funds for this article.

Proje Numarası

AEŞH-BADEK-2026-587

Etik Beyan

Approval for the study was obtained from the Ankara Etlik City Hospital Scientific Research Evaluation and Ethics Committee on 07/29/2026. Decision no: AEŞH-BADEK-2026-587.

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