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
Abstract
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.