A multicenter comparative acute myeloid leukemia study: can we explain the differences in the outcomes in
Douglas R A Silveira1,2, Juan L Coelho-Silva3, Wellington F Silva4
1Service of Hematology, Transfusion and Cell Therapy and Laboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31) HCFMUSP, University of Sao Paulo Medical School, Sao Paulo, Brazil.
Leukemia & Lymphoma
|September 30, 2020
Summary
Acute myeloid leukemia (AML) survival is worse in Brazil than the UK, with higher early deaths from infections and lower rates of hematopoietic stem cell transplant (HSCT). Improving infection control and HSCT access is crucial for better AML outcomes in Brazil.
Area of Science:
- Hematology
- Oncology
- Global Health
Background:
- Acute myeloid leukemia (AML) outcomes are influenced by patient, disease, treatment, and socioeconomic factors.
- Direct comparisons of AML outcomes between resource-constrained and developed nations are limited.
- Socioeconomic disparities significantly impact survival rates in hematologic malignancies.
Purpose of the Study:
- To compare outcomes for acute myeloid leukemia (AML) patients between a resource-constrained setting in Brazil and a developed country in the UK.
- To identify key factors contributing to survival differences in AML between the two cohorts.
- To inform strategies for improving AML treatment and survival in underserved regions.
Main Methods:
- Comparative analysis of two distinct patient cohorts: São Paulo, Brazil (USP) and Oxford, UK (OUH).
- Inclusion of 312 patients from USP and 158 patients from OUH.
- Statistical analysis of 5-year overall survival, early mortality, infection rates, relapse incidence, and hematopoietic stem cell transplant (HSCT) utilization and timing.
Main Results:
- The USP cohort exhibited significantly inferior 5-year overall survival (29% vs. 49%, p=.027) compared to the OUH cohort.
- Higher early mortality in USP (23% vs. 6%, p<.001) was primarily attributed to multi-resistant bacterial and fungal infections.
- The USP cohort had a higher incidence of relapse (60% vs. 50%, p=.0022) and significantly lower HSCT rates (28% vs. 75%, p<.001) with longer waiting times.
Conclusions:
- Significant disparities exist in acute myeloid leukemia (AML) outcomes between Brazil and the UK, highlighting the impact of resource availability.
- Infection prevention and control strategies are critical for reducing early mortality in AML patients in resource-constrained settings.
- Enhanced access to and timely administration of hematopoietic stem cell transplant (HSCT) are essential for improving survival rates in AML patients in Brazil.
