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

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Abstract

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.

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Data availability

Clinical data used for the study were collected and managed using REDCap electronic data capture tools.

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Author notes

  1. Fernanda Rodrigues Mendes and Wellington Fernandes da Silva contributed equally to this manuscript.

Authors and Affiliations

  1. 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

    Fernanda Rodrigues Mendes, Wellington Fernandes da Silva, Raphael da Costa Bandeira de Melo, Elvira Deolinda Rodrigues Pereira Velloso, Vanderson Rocha & Eduardo Magalhaes Rego

  2. 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

    Fernanda Rodrigues Mendes, Wellington Fernandes da Silva, Douglas Rafaele Almeida Silveira, Vanderson Rocha & Eduardo Magalhaes Rego

  3. Division of Hematology, Hospital das Clinicas da Faculdade de Medicina (HCFMUSP), Universidade de Sao Paulo, São Paulo, Brazil

    Raphael da Costa Bandeira de Melo, Elvira Deolinda Rodrigues Pereira Velloso, Vanderson Rocha & Eduardo Magalhaes Rego

  4. Myeloid Leukaemia Genomics and Biology Group, School of Cancer and Pharmaceutical Sciences, King’s College London, London, SE5 8AF, UK

    Douglas Rafaele Almeida Silveira

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  1. Fernanda Rodrigues Mendes
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Contributions

Conception and design of study: F.R.M., W.F.S., and E.M.R.; collection and assembly of data: F.R.M. and R.C.B.M.; data analysis and interpretation: W.F.S. and D.R.A.S.; manuscript writing: F.R.M. and W.F.S.; critical review: E.D.R.P.V., E.M.R., and V.R.

Corresponding author

Correspondence to Eduardo Magalhaes Rego.

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This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by local ethical committee.

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Informed consent was obtained from all patients for being included in the study.

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All patients provided written informed consent at data registration for publication purpose.

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The authors declare no competing interests.

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Mendes, F.R., da Silva, W.F., da Costa Bandeira de Melo, R. et al. Predictive factors associated with induction-related death in acute myeloid leukemia in a resource-constrained setting. Ann Hematol 101, 147–154 (2022). https://doi.org/10.1007/s00277-021-04687-6

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  • DOI: https://doi.org/10.1007/s00277-021-04687-6

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