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Survival and risk factors for mortality in pediatric patients with acute myeloid leukemia in a single reference center in low–middle-income country

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Abstract

Despite advances in therapy and care for children with acute myeloid leukemia (AML), survival rates for children in low- and middle-income countries (LMICs) remain poor. We studied risk factors for mortality and survival in children with AML in a LMIC to develop strategies to improve survival for AML children in these countries. This retrospective cohort (2000–2014) analyzed newly diagnosed AML patients (age < 19 years) at a reference center in Brazil. Demographic and clinical variables were reviewed by AML subtype: acute promyelocytic leukemia (APL), AML with Down syndrome (AML-DS), and other AML subtypes. Cumulative hazard risk for early death (ED) until 6 weeks of treatment and risk factors for mortality were determined by the multivariate Cox hazard models. Survival was assessed for each AML subtypes. A total of 220 patients were diagnosed: APL 50 (22.7%), AML-DS 16 (7.3%), and other AML subtypes 154 (70.0%). The cumulative hazard function values for ED for all patients with AML were 12.5% (95% CI 8.5–18.4%); for each AML patients subtypes: APL, 21.7% (95% CI 11.7–40.5%); AML-DS, 6.2% (95% CI 0.9–44.4%); and other AML subtypes, 10.2% (95% CI 6.2–17.0%). White blood cell count (cutoff 10 × 109/L for APL and 100 × 109/L for other AML subtypes) and Afro-descendance were significant risk factors for mortality in APL and other AML subtypes, respectively. Overall survival for patients with APL, AML-DS, and other AML subtypes was 66.8%, 62.5%, and 38.0%, respectively. APL patients had the highest incidence of ED and those with other subtypes had increased relapse risk. We also observed high rates of death in complete remission mainly due to infection. Better risk classification and identification of risk factors for infection may improve the survival of these patients.

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Acknowledgments

The authors are grateful to all members of Pediatric Oncology Unit, IMIP for support and assistance in data collection and Vani Shanker for editorial assistance.

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Authors and Affiliations

  1. Pediatric Oncology Unit, Instituto de Medicina Integral Prof. Fernando Figueira, Recife, PE, Brazil

    Mecneide Mendes Lins

  2. Pediatric Research Center, Instituto de Medicina Integral Prof. Fernando Figueira, Rua dos Coelhos, 300 Boa Vista, Recife, PE, 50070-550, Brazil

    Maria Julia Gonçalves Mello

  3. Department of Oncology and Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, USA

    Raul C Ribeiro

  4. Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA

    Raul C Ribeiro

  5. Research Center, Instituto Nacional de Câncer, Rio de Janeiro, Brazil

    Beatriz De Camargo & Luiz Claudio Santos Thuler

  6. Departamento de Saúde Coletiva (Collective Health Department) of CPqAM, FIOCRUZ, Recife, Brazil

    Maria de Fátima Pessoa Militão de Albuquerque

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  1. Mecneide Mendes Lins
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  2. Maria Julia Gonçalves Mello
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  5. Maria de Fátima Pessoa Militão de Albuquerque
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  6. Luiz Claudio Santos Thuler
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Corresponding author

Correspondence to Maria Julia Gonçalves Mello.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

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Lins, M.M., Mello, M.J.G., Ribeiro, R.C. et al. Survival and risk factors for mortality in pediatric patients with acute myeloid leukemia in a single reference center in low–middle-income country. Ann Hematol 98, 1403–1411 (2019). https://doi.org/10.1007/s00277-019-03661-7

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