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

Autor: Silveira DRA; Service 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.; Department of Hematology, AC Camargo Cancer Center, Sao Paulo, Brazil., Coelho-Silva JL; Department of Medical Images, Hematology and Clinical Oncology, University of Sao Paulo at Ribeirao Preto Medical School (FMRP), Ribeirao Preto, Brazil., Silva WF; Leukemia Unit, Cancer Institute of Sao Paulo (ICESP), University of Sao Paulo Medical School, Sao Paulo, Brazil., Vallance G; Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK., Pereira-Martins DA; Department of Medical Images, Hematology and Clinical Oncology, University of Sao Paulo at Ribeirao Preto Medical School (FMRP), Ribeirao Preto, Brazil., Madeira MIA; Department of Medical Images, Hematology and Clinical Oncology, University of Sao Paulo at Ribeirao Preto Medical School (FMRP), Ribeirao Preto, Brazil., Figueredo-Pontes LL; Department of Medical Images, Hematology and Clinical Oncology, University of Sao Paulo at Ribeirao Preto Medical School (FMRP), Ribeirao Preto, Brazil., Velloso EDRP; Service 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 Unit, Cancer Institute of Sao Paulo (ICESP), University of Sao Paulo Medical School, Sao Paulo, Brazil., Simões BP; Department of Medical Images, Hematology and Clinical Oncology, University of Sao Paulo at Ribeirao Preto Medical School (FMRP), Ribeirao Preto, Brazil., Peniket A; Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK., Danby R; Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK., Rego EM; Service 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 Unit, Cancer Institute of Sao Paulo (ICESP), University of Sao Paulo Medical School, Sao Paulo, Brazil., Vyas P; Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.; MRC MHU, BRC Haematology Theme, Oxford Biomedical Research Center, Oxford Center for Hematology, WIMM, Radcliffe Department of Medicine, University of Oxford, Oxford, UK., Traina F; Department of Medical Images, Hematology and Clinical Oncology, University of Sao Paulo at Ribeirao Preto Medical School (FMRP), Ribeirao Preto, Brazil., Bendit I; Service 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., Quek L; Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK., Rocha V; Service 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 Unit, Cancer Institute of Sao Paulo (ICESP), University of Sao Paulo Medical School, Sao Paulo, Brazil.; Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
Jazyk: angličtina
Zdroj: Leukemia & lymphoma [Leuk Lymphoma] 2021 Jan; Vol. 62 (1), pp. 147-157. Date of Electronic Publication: 2020 Sep 30.
DOI: 10.1080/10428194.2020.1827252
Abstrakt: 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.
Databáze: MEDLINE
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