Predictive factors associated with induction-related death in acute myeloid leukemia in a resource-constrained setting.

Autor: Mendes FR; Division of Hematology, Instituto do Cancer do Estado de São Paulo (ICESP), Faculdade de Medicina da Universidade de Sao Paulo, Av. Dr. Arnaldo, 251, Cerqueira César, São Paulo, CEP 01246-000, Brazil.; Laboratory of Medical Investigation in Pathogenesis and Targeted Therapy in Onco-Immuno-Hematology (LIM-31), Department of Hematology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil., da Silva WF; Division of Hematology, Instituto do Cancer do Estado de São Paulo (ICESP), Faculdade de Medicina da Universidade de Sao Paulo, Av. Dr. Arnaldo, 251, Cerqueira César, São Paulo, CEP 01246-000, Brazil.; Laboratory of Medical Investigation in Pathogenesis and Targeted Therapy in Onco-Immuno-Hematology (LIM-31), Department of Hematology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil., da Costa Bandeira de Melo R; Division of Hematology, Instituto do Cancer do Estado de São Paulo (ICESP), Faculdade de Medicina da Universidade de Sao Paulo, Av. Dr. Arnaldo, 251, Cerqueira César, São Paulo, CEP 01246-000, Brazil.; Division of Hematology, Hospital das Clinicas da Faculdade de Medicina (HCFMUSP), Universidade de Sao Paulo, São Paulo, Brazil., Silveira DRA; Laboratory of Medical Investigation in Pathogenesis and Targeted Therapy in Onco-Immuno-Hematology (LIM-31), Department of Hematology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil.; Myeloid Leukaemia Genomics and Biology Group, School of Cancer and Pharmaceutical Sciences, King's College London, London, SE5 8AF, UK., Velloso EDRP; Division of Hematology, Instituto do Cancer do Estado de São Paulo (ICESP), Faculdade de Medicina da Universidade de Sao Paulo, Av. Dr. Arnaldo, 251, Cerqueira César, São Paulo, CEP 01246-000, Brazil.; Division of Hematology, Hospital das Clinicas da Faculdade de Medicina (HCFMUSP), Universidade de Sao Paulo, São Paulo, Brazil., Rocha V; Division of Hematology, Instituto do Cancer do Estado de São Paulo (ICESP), Faculdade de Medicina da Universidade de Sao Paulo, Av. Dr. Arnaldo, 251, Cerqueira César, São Paulo, CEP 01246-000, Brazil.; Laboratory of Medical Investigation in Pathogenesis and Targeted Therapy in Onco-Immuno-Hematology (LIM-31), Department of Hematology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil.; Division of Hematology, Hospital das Clinicas da Faculdade de Medicina (HCFMUSP), Universidade de Sao Paulo, São Paulo, Brazil., Rego EM; Division of Hematology, Instituto do Cancer do Estado de São Paulo (ICESP), Faculdade de Medicina da Universidade de Sao Paulo, Av. Dr. Arnaldo, 251, Cerqueira César, São Paulo, CEP 01246-000, Brazil. eduardo.rego@fm.usp.br.; Laboratory of Medical Investigation in Pathogenesis and Targeted Therapy in Onco-Immuno-Hematology (LIM-31), Department of Hematology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil. eduardo.rego@fm.usp.br.; Division of Hematology, Hospital das Clinicas da Faculdade de Medicina (HCFMUSP), Universidade de Sao Paulo, São Paulo, Brazil. eduardo.rego@fm.usp.br.
Jazyk: angličtina
Zdroj: Annals of hematology [Ann Hematol] 2022 Jan; Vol. 101 (1), pp. 147-154. Date of Electronic Publication: 2021 Oct 21.
DOI: 10.1007/s00277-021-04687-6
Abstrakt: Despite advances in supportive measures, acute myeloid leukemia (AML) remission induction still has a high mortality rate in real-world studies as compared to prospective reports. We analyzed data from 206 AML adult patients treated with conventional chemotherapy. The primary endpoint was the 60-day mortality rate, aiming to find risk factors and to examine the role of anti-infection prophylaxis. The 60-day mortality rate was 26%, raising to 41% among those older than 60 years. Complete response was documented at the end of induction in 49%. The final survival model showed that age > 60 years (HR 3.2), Gram-negative colonization (HR 3), monocytic AML (HR 1.8), C-reactive protein (CRP) > 15 mg/dL (HR 10), and an adverse risk in the genetic stratification (HR 3) were associated with induction death. Multidrug-resistant bacteria colonization, thrombosis, and AKI were documented in 71%, 12%, and 66% of the cohort, respectively. Antibacterial and antifungal prophylaxis did not improve outcomes in this study. Our report corroborated the higher mortality during AML induction compared to real-world data from the USA and Europe. In line with other publications, age and cytogenetic stratification influenced early death in this cohort. Noticeably, Gram-negative colonization, monocytic AML, and CRP were also significant to early mortality.
(© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze: MEDLINE
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