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

Journal article

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.

Authors: Silveira, DRA; Coelho-Silva, JL; Silva, WF; Vallance, G; Pereira-Martins, DA

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Taylor and Francis
• Journal: Leukemia and Lymphoma
• Volume: 62
• Issue: 1
• Pages: 147-157
• Publication date: 2020-09-30
• Acceptance date: 2020-09-18
• DOI: 10.1080/10428194.2020.1827252
• EISSN: 1029-2403
• ISSN: 1042-8194
• Pmid: 32996373
• Language: English
• Keywords: Brazil; United Kingdom; hematopoietic stem cell transplantation; FFR; retrospective studies; leukemia, myeloid, acute; graft vs host disease; humans