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Evaluating Risk Factors for Early Mortality in Adult ALL in Brazil.

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Early mortality in adult acute lymphoblastic leukemia (ALL) is high in low-income countries. Low albumin and prephase cyclophosphamide use are key risk factors for early death in these patients.

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Area of Science:

  • Hematology
  • Oncology
  • Global Health

Background:

  • Adult acute lymphoblastic leukemia (ALL) treatment relies on intensive chemotherapy.
  • Novel agents are often inaccessible in low- and middle-income countries (LMICs).
  • Early mortality (EM) rates in LMICs are significantly higher (10-25%) compared to high-income countries (<5%).

Purpose of the Study:

  • To identify risk factors for early mortality (EM) in adult ALL patients in LMICs.
  • To inform the development of context-specific interventions for reducing EM.
  • To address challenges in ALL management within resource-limited settings.

Main Methods:

  • Retrospective cohort study of adult ALL patients (≥15 years) diagnosed between 2009-2023.
  • Early mortality defined as death within 30 days of diagnosis.
  • Analysis included patients regardless of phenotype or Philadelphia chromosome status.

Main Results:

  • Overall EM was 9.8% in 203 patients (median age 36).
  • Significant EM predictors included age, low albumin, cyclophosphamide use, and obesity.
  • Low albumin and prephase cyclophosphamide use were strongly associated with increased infection risk and EM.

Conclusions:

  • Elevated EM in LMICs reflects challenges like late diagnosis and limited supportive care.
  • Low albumin and prephase cyclophosphamide are critical risk markers for EM in adult ALL.
  • Locally adapted protocols and simple risk stratification are needed to decrease EM in LMICs.