Predictive factors associated with induction-related death in acute myeloid leukemia in a resource-constrained setting

Author(s)

Mendes, Fernanda Rodrigues ^{[1, 2]} ; da Silva, Wellington Fernandes ^{[1, 2]} ; da Costa Bandeira de Melo, Raphael ^{[1, 3, 4]} ; Silveira, Douglas Rafaele Almeida ^[2] ; Velloso, Elvira Deolinda Rodrigues Pereira ^{[1, 3]} ; Rocha, Vanderson ^{[1, 2, 3]} ; Rego, Eduardo Magalhaes ^{[1, 2, 3]}

Affiliation

^[1] Univ Sao Paulo, Fac Med, Inst Canc Estado Sao Paulo ICESP, Div Hematol, Av Dr Arnaldo 251, BR-01246000 Sao Paulo, SP - Brazil

^[2] Univ Sao Paulo, Hosp Clin HCFMUSP, Fac Med, Dept Hematol, Lab Med Invest Pathogenesis & Target, Sao Paulo - Brazil

^[3] Univ Sao Paulo, Hosp Clin, Fac Med HCFMUSP, Sao Paulo - Brazil

^[4] Kings Coll London, Sch Canc & Pharmaceut Sci, Myeloid Leukaemia Genom & Biol Grp, London SE5 8AF - England

• Document type: Journal article
• Source: ANNALS OF HEMATOLOGY; v. 101, n. 1 OCT 2021.
• Web of Science Citations: 0

Abstract

Despite advances in supportive measures, acute myeloid leukemia (AML) remission induction still has a high mortality rate in real-world studies as compared to prospective reports. We analyzed data from 206 AML adult patients treated with conventional chemotherapy. The primary endpoint was the 60-day mortality rate, aiming to find risk factors and to examine the role of anti-infection prophylaxis. The 60-day mortality rate was 26%, raising to 41% among those older than 60 years. Complete response was documented at the end of induction in 49%. The final survival model showed that age > 60 years (HR 3.2), Gram-negative colonization (HR 3), monocytic AML (HR 1.8), C-reactive protein (CRP) > 15 mg/dL (HR 10), and an adverse risk in the genetic stratification (HR 3) were associated with induction death. Multidrug-resistant bacteria colonization, thrombosis, and AKI were documented in 71%, 12%, and 66% of the cohort, respectively. Antibacterial and antifungal prophylaxis did not improve outcomes in this study. Our report corroborated the higher mortality during AML induction compared to real-world data from the USA and Europe. In line with other publications, age and cytogenetic stratification influenced early death in this cohort. Noticeably, Gram-negative colonization, monocytic AML, and CRP were also significant to early mortality. (AU)

• FAPESP's process: 13/08135-2 - CTC - Center for Cell-Based Therapy
• Grantee: Dimas Tadeu Covas
• Support Opportunities: Research Grants - Research, Innovation and Dissemination Centers - RIDC