Evaluation of the European LeukemiaNet recommendations for predicting outcomes of patients with acute myeloid leukemia treated in low- and middle-income countries (LMIC): A Brazilian experience.

Autor: Benicio MTL; Department of Internal Medicine, Medical School of Ribeirao Preto, Ribeirao Preto, Brazil., Ribeiro AFT; Postgraduate Program in Pathology, Federal University of Minas Gerais, Belo Horizonte, Brazil; Hematology Unit, Federal University of Minas Gerais, Belo Horizonte, Brazil., Américo AD; Department of Internal Medicine, Medical School of Ribeirao Preto, Ribeirao Preto, Brazil., Furtado FM; Department of Internal Medicine, Medical School of Ribeirao Preto, Ribeirao Preto, Brazil., Glória AB; Hematology Unit, Federal University of Minas Gerais, Belo Horizonte, Brazil., Lima AS; Department of Genetics, Federal University of Pernambuco, Recife, Brazil., Santos SM; Department of Clinical Pathology, Federal University of Minas Gerais, Belo Horizonte, Brazil., Xavier SG; Department of Clinical Pathology, Federal University of Minas Gerais, Belo Horizonte, Brazil., Lucena-Araujo AR; Department of Genetics, Federal University of Pernambuco, Recife, Brazil., Fagundes EM; Hematology Unit, Federal University of Minas Gerais, Belo Horizonte, Brazil., Rego EM; Department of Internal Medicine, Medical School of Ribeirao Preto, Ribeirao Preto, Brazil; Center for Cell Based Therapy, University of Sao Paulo, Ribeirao Preto, Brazil. Electronic address: emrego@hcrp.usp.br.
Jazyk: angličtina
Zdroj: Leukemia research [Leuk Res] 2017 Sep; Vol. 60, pp. 109-114. Date of Electronic Publication: 2017 Jul 24.
DOI: 10.1016/j.leukres.2017.07.005
Abstrakt: Background: Current results regarding treatment outcomes in acute myeloid leukemia (AML) point to significant differences between low- and middle-income countries (LMIC) and high-income countries (HIC). Excluding well-known socioeconomic issues, genetic markers important for prognosis have not been properly incorporated into the clinical practice so far and their usefulness outside of well-controlled clinical trials remain unknown.
Methods: Here, we assessed the clinical significance of the European LeukemiaNet (ELN) recommendations in 196 consecutive patients with AML in a real-life setting. All patients were younger than 60 years of age (49% male) and treated with conventional chemotherapy for induction and consolidation in three Brazilian Institutions that well represent Brazilian geographic and socioeconomic diversity.
Findings: Multivariable analysis showed that ELN recommendations had a slight association with complete remission achievement (odds ratio: 0.74, 95% confidence interval, CI: 0.53-1.01; P=0.06), but were independently associated with poor overall survival (OS) (hazard ratio, HR: 1.3, 95% CI: 1.1-1.54; P=0.002), disease-free survival (DFS) (HR: 1.42, 95% CI: 1.03-1.95; P=0.028) and event-free survival (EFS) (HR: 1.24, 95% CI: 1.06-1.47; P=0.007), considering initial leukocyte counts and age as confounders. ELN recommendations had no impact on cumulative incidence of relapse (P=0.09).
Interpretation: Our results suggest that within the context of LMIC, the prognostic markers recommended by ELN may be useful to predict patient's clinical outcomes; however, the OS, DFS and EFS were shorter than the reported in Europe and US for the respective risk groups.
(Copyright © 2017 Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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