1. A multicenter comparative acute myeloid leukemia study: can we explain the differences in the outcomes in resource-constrained settings?
- Author
-
Silveira, Douglas R. A., Coelho-Silva, Juan L., Silva, Wellington F., Vallance, Grant, Pereira-Martins, Diego A., Madeira, Maria I. A., Figueredo-Pontes, Lorena L., Velloso, Elvira D. R. P., Simões, Belinda P., Peniket, Andy, Danby, Robert, Rego, Eduardo M., Vyas, Paresh, Traina, Fabiola, Bendit, Israel, Quek, Lynn, and Rocha, Vanderson
- Subjects
ACUTE myeloid leukemia ,GRAM-negative bacterial diseases ,STEM cell transplantation ,HEMATOPOIETIC stem cells ,INFECTION prevention - 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 São 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. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF