A newly developed heavy metal baseline score appears to be prognostic for survival outcomes in patients with acute myeloid leukemia (AML), according to a study published in the American Journal of Hematology.

Researchers hypothesized that imbalances of toxic and essential metals would exist in patients with AML relative to healthy individuals and that lower values of essential metals and higher values of toxic metals would be associated with poorer outcomes patients with AML.

Serum samples were collected to quantify metal values for both groups. The samples were assessed for trace metals and copper isotopic abundance ratios (19 in total) using mass spectrometry. Then, the researchers conducted survival analyses and developed the comprehensive, multimetal baseline score for patients with AML.

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Overall, 67 patients with untreated AML and 94 control individuals participated in the study. Of the 19 metal values, 13 were significantly different between the AML and control groups. In univariate survival analysis, lower levels of calcium (P =.005), magnesium (P =.02), and selenium (P =.004) and higher level of cadmium (P =.02) were associated with worse survival rates. In multivariate survival analysis, patients with a combination of lower magnesium (< 1.07 mmol/L) and higher cadmium (≥ 0.729 nmol/L) values had the lowest survival rate at 6 months (P =.001).

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The novel metal score includes values of 5 toxic and 5 essential metals. For each patient, 1 point is given for each metal that falls outside of a predetermined limit; the points are then summed to a total score. The team found that higher metal scores were associated with worse 6-month survival, with rates of 81% for a score between 1 and 3, 60% for a score between 4 and 6, and 36% for a score greater than 6 (P =.01). The researchers were also able to verify this association in a second, independent population with AML.

“This study is first of its kind to analyze the associations between metals and survival in AML and to confirm a metal-scoring system that was significantly prognostic in 2 independent patient populations treated on separate continents,” the researchers wrote. “Our results suggest that further research into the role of heavy metals in AML is warranted.”


  1. Ohanian M, Telouk P, Kornblau S, et al. A heavy metal baseline score predicts outcome in AML [published online January 16, 2020]. Am J Hematol. doi:10.1002/ajh.25731

This article originally appeared on Hematology Advisor