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

Benício, Mariana Tereza de Lira; Ribeiro, Ana Flávia Tibúrcio; Américo, André Dias; Furtado, Felipe Magalhães; Glória, Ana; Lima, Aleide S.; Santos, Silvana Maria Elói; Xavier, Sandra Guerra; Lucena-Araújo, Antonio R.; Fagundes, Evandro M.; Rego, Eduardo Magalhães

doi:10.1016/j.leukres.2017.07.005

Cited by 17 publications

(16 citation statements)

References 31 publications

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“…A gender-based distribution of the data was also observed, where the men were diagnosed more than women with a ratio of 1 : 1.23, a finding that is consistent with that reported in international studies [ 19 , 20 ] but no with Latin American and Colombia studies [ 11 , 12 , 15 , 16 , 21 ]. The problem with this incidence and the results obtained is that our study is not based in a demographic registry and the sample size is limited, which cannot be reflecting the real behavior in our population.…”

Section: Discussionsupporting

confidence: 87%

“…In Latin America, survival has been always lower than in high-income countries. Brazil has reported different OS for AML; the 5-year OS has been between 17.0% and 23.0% [ 14 – 16 ]. In Mexico, a 25 months OS was described [ 17 ], and in a single institution study in Chile, the median OS was 24 months [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

“…This response rate is similar to what is obtained at the national and international levels, where it is between 65.1% [ 11 ] and 70.0% [ 27 ], respectively. Brazil studies with the same chemotherapeutic protocol have reported a postinduction hematological remission of 57.0% [ 14 ], 40.0% [ 15 ], and 43.0% [ 16 ]; Mexico described a 84.0% remission in a 21 patients study and Chile between 65.0 and 81.0% [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

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Influence of Dose Intensity in Consolidation with HIDAC and Other Clinical and Biological Parameters in the Survival of AML

Ballesteros-Ramírez

Quijano

Solano

et al. 2020

Journal of Cancer Epidemiology

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Background. The impact of the dose intensity administered in consolidation in Latin America is unknown. This study aimed to evaluate the relative dose intensity (RDI) in consolidation and its impact in overall survival. Methods. A retrospective study of 86 patients with AML who were diagnosed between 2010 and 2016 with a 2-year follow-up in a fourth-level Colombian hospital was carried out. Clinical characteristics were reported, Kaplan-Meier was used for estimating the overall survival, and Cox regression was used for multivariate analysis. Results. The median overall survival (OS) was 20.83 months, and the median event-free survival (EFS) was 16.83 months. 64.3% of the patients achieved remission after the 7+3 chemotherapy induction treatment. Patients under 30 years of age, with white blood cell counts less than 100.000 cells/mm3 who responded to induction treatment had a better OS. Additionally, patients receiving an RDI greater than 0.75 of the planned consolidation dose had better survival. The prognostic variables with impact in the OS were the leukocyte count in peripheral blood at diagnosis, the RDI in consolidation treatment with HIDAC and the response obtained after induction. Conclusion. This retrospective study allowed us to know the epidemiology of AML in a reference Colombian Hospital. Additionally, in our knowledge, it is the first study that reports the RDI in consolidation with HIDAC in Latin America as a prognostic factor that directly impacts the OS.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Influence of Dose Intensity in Consolidation with HIDAC and Other Clinical and Biological Parameters in the Survival of AML

Ballesteros-Ramírez

Quijano

Solano

et al. 2020

Journal of Cancer Epidemiology

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“…A recent study using mitoxantrone in combination with FLAG showed an outstanding CR rate of 73%, raising issues on the choice of anthracycline for r/rAML treatment (29). Greater treatment-related toxicity has already been reported in patients with acute leukemia in Latin America, even though no previous study has addressed this subgroup of adult patients with refractory or relapsed disease in Latin America (5,(31)(32)(33)(34). By comparing the CR and survival endpoints between MEC and FLAG-IDA, no remarkable difference was noticed in CR and EFS, with only the FLT3-ITD status and execution of SCT remaining as significant factors for survival in our cohort.…”

Section: ' Discussionmentioning

confidence: 99%

“…It is estimated that only 15%-40% of patients achieve long-term survival with current approaches, which include genetic risk stratification and allogeneic stem-cell transplantation (SCT) for intermediate-high risk subjects (2,3). Although toxicity is a major concern when treating AML in adults, the high refractoriness and rate of relapse seems to be the leading cause of death, even in developing countries (4,5).…”

Section: ' Introductionmentioning

confidence: 99%

Salvage treatment for refractory or relapsed acute myeloid leukemia: a 10-year single-center experience

Silva¹,

Rosa²,

Seguro³

et al. 2020

Clinics

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OBJECTIVES: The outcomes of refractory and relapsed acute myeloid leukemia (AML) patients in developing countries are underreported, even though the similar classic regimens are widely used. METHODS: We conducted a retrospective comparison of ''MEC'' (mitoxantrone, etoposide, and cytarabine) and ''FLAG-IDA'' (fludarabine, cytarabine, idarubicin, and filgrastim) in adults with first relapse or refractory AML. RESULTS: In total, 60 patients were included, of which 28 patients received MEC and 32 received FLAG-IDA. A complete response (CR) rate of 48.3% was observed. Of the included patients, 16 (27%) died before undergoing bone marrow assessment. No statiscally significant difference in CR rate was found between the two protocols (p=0.447). The median survival in the total cohort was 4 months, with a 3-year overall survival (OS) rate of 9.7%. In a multivariable model including age, fms-like tyrosine kinase 3 (FLT3) status, and stem-cell transplantation (SCT), only the last two indicators remained significant: FLT3-ITD mutation (hazard ratio [HR] =4.6, po0.001) and SCT (HR=0.43, p=0.01). CONCLUSION: In our analysis, there were no significant differences between the chosen regimens. High rates of early toxicity were found, emphasizing the role of supportive care and judicious selection of patients who are eligible for intensive salvage therapy in this setting. The FLT3-ITD mutation and SCT remained significant factors for survival in our study, in line with the results of previous studies.

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

et al. 2021

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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

Cited by 17 publications

References 31 publications

Influence of Dose Intensity in Consolidation with HIDAC and Other Clinical and Biological Parameters in the Survival of AML

Influence of Dose Intensity in Consolidation with HIDAC and Other Clinical and Biological Parameters in the Survival of AML

Salvage treatment for refractory or relapsed acute myeloid leukemia: a 10-year single-center experience

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

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