Prognostic impact of fever at presentation in acute myeloid leukemia: a retrospective cohort study

Fever at presentation is a common clinical feature in acute myeloid leukemia (AML), yet its prognostic significance before chemotherapy initiation remains unclear. This retrospective, population-based study analyzed 198 AML patients in southern Israel from 2013 to 2023. Fever was present in 28.3% of patients and was associated with higher one-year (53.5% vs. 45.1%, <i>p</i> = 0.030) and five-year mortality rates (67.8% vs. 57.0%, <i>p</i> = 0.017). Multivariable analysis showed that fever ≥38 °C increased one-year mortality risk (OR 1.39, 95% CI 1.06-2.58, <i>p</i> = 0.05), rising to 1.93 for fever ≥39 °C (95% CI 1.17-2.95, <i>p</i> = 0.02). Median event-free survival was shorter in febrile patients (HR 1.63, 95% CI 1.14-2.35, <i>p</i> = 0.008), with greater association at fever ≥39 °C (HR 2.08, 95% CI 1.23-3.53, <i>p</i> = 0.006). Fever's prognostic association varied by age and infection status. These findings suggest that fever at presentation may serve as a clinical marker of poor prognosis in AML, warranting closer monitoring and tailored management to improve outcomes.