Evaluation of the European LeukemiaNet recommendations for predicting outcomes of patients with acute myeloid leukemia treated in low- and middle-income countries (LMIC): A Brazilian experience

Author(s):Show less -

de Lira Benicio, Mariana Tereza ^[1] ; Tiburcio Ribeiro, Ana Flavia ^{[2, 3]} ; Americo, Andre D. ^[1] ; Furtado, Felipe M. ^[1] ; Gloria, Ana B. ^[2] ; Lima, Aleide S. ^[4] ; Santos, Silvana M. ^[5] ; Xavier, Sandra G. ^[5] ; Lucena-Araujo, Antonio R. ^[4] ; Fagundes, Evandro M. ^[2] ; Rego, Eduardo M. ^{[1, 6]}

Affiliation

^[1] Med Sch Ribeirao Preto, Dept Internal Med, Ribeirao Preto - Brazil

^[2] Univ Fed Minas Gerais, Hematol Unit, Belo Horizonte, MG - Brazil

^[3] Univ Fed Minas Gerais, Postgrad Program Pathol, Belo Horizonte, MG - Brazil

^[4] Univ Fed Pernambuco, Dept Genet, Recife, PE - Brazil

^[5] Univ Fed Minas Gerais, Dept Clin Pathol, Belo Horizonte, MG - Brazil

^[6] Univ Sao Paulo, Ctr Cell Based Therapy, Av Bandeirantes 3900, Campus USP, BR-14048900 Ribeirao Preto, SP - Brazil

• Document type: Journal article
• Source: Leukemia Research; v. 60, p. 109-114, SEP 2017.
• Web of Science Citations: 4

Abstract

Background: Current results regarding treatment outcomes in acute myeloid leukemia (AML) point to significant differences between low-and middle-income countries (LMIC) and high-income countries (HIC). Excluding well-known socioeconomic issues, genetic markers important for prognosis have not been properly incorporated into the clinical practice so far and their usefulness outside of well-controlled clinical trials remain unknown. Methods: Here, we assessed the clinical significance of the European LeukemiaNet (ELN) recommendations in 196 consecutive patients with AML in a real-life setting. All patients were younger than 60 years of age (49% male) and treated with conventional chemotherapy for induction and consolidation in three Brazilian Institutions that well represent Brazilian geographic and socioeconomic diversity. Findings: Multivariable analysis showed that ELN recommendations had a slight association with complete remission achievement (odds ratio: 0.74, 95% confidence interval, CI: 0.53-1.01; P = 0.06), but were independently associated with poor overall survival (OS) (hazard ratio, HR: 1.3, 95% CI: 1.1-1.54; P=0.002), disease-free survival (DFS) (HR: 1.42, 95% CI: 1.03-1.95; P = 0.028) and event-free survival (EFS) (HR: 1.24, 95% CI: 1.06-1.47; P=0.007), considering initial leukocyte counts and age as confounders. ELN recommendations had no impact on cumulative incidence of relapse (P = 0.09). Interpretation: Our results suggest that within the context of LMIC, the prognostic markers recommended by ELN may be useful to predict patient's clinical outcomes; however, the OS, DFS and EFS were shorter than the reported in Europe and US for the respective risk groups. (AU)

• FAPESP's process: 08/57895-1 - National Institute of Blood Technology and Science
• Grantee: Sara Teresinha Olalla Saad
• Support Opportunities: Research Projects - Thematic Grants
• FAPESP's process: 11/17112-0 - Assessment of signaling pathways in stem-cells of de novo acute myeloid leukemia
• Grantee: Mariana Tereza de Lira Benício
• Support Opportunities: Scholarships in Brazil - Doctorate