A multicenter comparative acute myeloid leukemia study: can we explain the differences in the outcomes in resource-constrained settings?

Author(s):Show less -

Silveira, Douglas R. A. ^{[1, 2, 3]} ; Coelho-Silva, Juan L. ^[4] ; Silva, Wellington F. ^[5] ; Vallance, Grant ^[6] ; Pereira-Martins, Diego A. ^[4] ; Madeira, Maria I. A. ^[4] ; Figueredo-Pontes, Lorena L. ^[4] ; Velloso, Elvira D. R. P. ^{[2, 3, 5]} ; Simoes, Belinda P. ^[4] ; Peniket, Andy ^[6] ; Danby, Robert ^[6] ; Rego, Eduardo M. ^{[2, 3, 5]} ; Vyas, Paresh ^{[6, 7]} ; Traina, Fabiola ^[4] ; Bendit, Israel ^{[2, 3]} ; Quek, Lynn ^[8] ; Rocha, Vanderson ^{[2, 3, 5, 6]}

Affiliation

^[1] AC Camargo Canc Ctr, Dept Hematol, Sao Paulo - Brazil

^[2] Univ Sao Paulo, Med Sch, Serv Hematol Transfus & Cell Therapy, Sao Paulo - Brazil

^[3] Univ Sao Paulo, Med Sch, Lab Med Invest Pathogenesis & Directed Therapy On, Sao Paulo - Brazil

^[4] Univ Sao Paulo, Ribeirao Preto Med Sch FMRP, Dept Med Images Hematol & Clin Oncol, Ribeirao Preto - Brazil

^[5] Univ Sao Paulo, Canc Inst Sao Paulo ICESP, Leukemia Unit, Med Sch, Sao Paulo, SP - Brazil

^[6] Oxford Univ Hosp NHS Fdn Trust, Dept Haematol, Oxford - England

^[7] Univ Oxford, Radcliffe Dept Med, Oxford Ctr Hematol, WIMM, MRC MHU, BRC Haematol Theme, Oxford Biomed Res Ctr, Oxford - England

^[8] Kings Coll Hosp NHS Fdn Trust, Dept Haematol Med, London - England

• Document type: Journal article
• Source: Leukemia & Lymphoma; v. 62, n. 1, p. 147-157, JAN 2 2021.
• Web of Science Citations: 0

Abstract

Outcomes in acute myeloid leukemia (AML) are dependent on patient- and disease-characteristics, treatment, and socioeconomic factors. AML outcomes between resource-constrained and developed countries have not been compared directly. We analyzed two cohorts: from Sao Paulo state, Brazil (USP,n = 312) and Oxford, United Kingdom (OUH,n = 158). USP cohort had inferior 5-year overall survival compared with OUH (29% vs. 49%, adjusted-p=.027). USP patients have higher early-mortality (23% vs. 6%p<.001) primarily due to multi-resistant Gram-negative bacterial and fungal infections. USP had higher 5-year cumulative incidence of relapse (60% vs. 50%,p=.0022), were less likely to undergo hematopoietic stem cell transplant (HSCT) (28% vs. 75%,p<.001) and waited longer for HSCT (median, 23.8 vs. 7.2 months,p<.001). Three-year survival in relapsed patients was worse in USP than OUH (10% vs. 39%,p<.001). Our study indicates that efforts to improve AML outcomes in Brazil should focus on infection prevention and control, and access to HSCT. (AU)

• FAPESP's process: 16/23191-4 - Investigation of IRS2 role on the pathogenesis of myeloproliferative neoplasms JAK2V617F using murine models
• Grantee: Juan Luiz Coelho da Silva
• Support Opportunities: Scholarships in Brazil - Doctorate
• FAPESP's process: 17/23117-1 - Evaluation of TP53/TP73 pathway in engraftment of acute promyelocytic leukemia cells in xenotransplantation model
• Grantee: Diego Antonio Pereira Martins
• Support Opportunities: Scholarships in Brazil - Doctorate