Hematology and Oncology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
Hematology Department, Instituto Nacional de Cancerología, Mexico City, Mexico.
Clin Lymphoma Myeloma Leuk. 2020 Jun;20(6):e295-e303. doi: 10.1016/j.clml.2019.12.015. Epub 2019 Dec 26.
In the past decades, long-term survival outcomes for younger patients with acute myeloid leukemia (AML) have improved. Nonetheless, developing nations might be lagging behind, highlighting the need to assess real-world outcomes in such regions.
We performed a multicenter retrospective study, which included patients with AML diagnosed between January 2013 and December 2017 from 13 centers in Mexico.
A total of 525 patients with AML met the inclusion criteria and were included in the study. Median age for the entire cohort was 47 years. The patients were classified according to cytogenetic risk: favorable 16.0%, intermediate 55.6%, and unfavorable 28.4%. Most patients received intensive chemotherapy (80.2%), and among these 74.1% underwent a 7 + 3 induction regimen. A complete remission was achieved in 71.3% of patients. Induction-related mortality occurred in 17.8% and we identify the following as independent risk factors: >60 years (odds ratio [OR] 2.09 [1.09-4.02]), Eastern Cooperative Oncology Group >2 (OR 4.82 [2.46-9.43]), prior solid tumor (OR 3.8 [1.24-11.59]) and active infection (OR 1.82 [1.06-3.12]). Further, allogeneic hematopoietic stem-cell transplantation (AlloHSCT) was performed in 8.2% in CR1. The 3-year overall survival (OS) was 34.8%. In a multivariate analysis, several factors were independently associated with a worse OS, including secondary AML (hazard ratio [HR] 2.14 [1.15-4.01]) and unfavorable cytogenetic risk (HR 1.81 [1.16-2.82]), whereas maintenance therapy (HR 0.53 [0.32-0.86]) and AlloHSCT (HR 0.40 [0.17-0.94]) were associated with better OS.
This is the first multicenter report analyzing AML survival in Mexico. Challenges in this setting include a high induction-related mortality and low AlloHSCT rate, which should be addressed to improve outcomes.
在过去的几十年中，年轻急性髓系白血病（AML）患者的长期生存结果有所改善。然而，发展中国家可能落后了，这凸显了评估这些地区实际结果的必要性。
我们进行了一项多中心回顾性研究，该研究纳入了 2013 年 1 月至 2017 年 12 月期间来自墨西哥 13 个中心的诊断为 AML 的患者。
共有 525 名 AML 患者符合纳入标准并纳入本研究。整个队列的中位年龄为 47 岁。根据细胞遗传学风险进行分类：预后良好 16.0%，中等 55.6%，预后不良 28.4%。大多数患者接受强化化疗（80.2%），其中 74.1%接受 7+3 诱导方案。71.3%的患者达到完全缓解。诱导相关死亡率为 17.8%，我们确定以下为独立危险因素：>60 岁（比值比[OR]2.09[1.09-4.02]）、东部合作肿瘤组>2（OR 4.82[2.46-9.43]）、既往实体瘤（OR 3.8[1.24-11.59]）和活动性感染（OR 1.82[1.06-3.12]）。此外，在 CR1 中进行了异基因造血干细胞移植（AlloHSCT）治疗的患者占 8.2%。3 年总生存率（OS）为 34.8%。在多变量分析中，几个因素与较差的 OS 独立相关，包括继发性 AML（风险比[HR]2.14[1.15-4.01]）和不良细胞遗传学风险（HR 1.81[1.16-2.82]），而维持治疗（HR 0.53[0.32-0.86]）和 AlloHSCT（HR 0.40[0.17-0.94]）与较好的 OS 相关。
这是第一份分析墨西哥 AML 生存情况的多中心报告。该环境中的挑战包括诱导相关死亡率高和 AlloHSCT 率低，应解决这些问题以改善结果。
