Mariana Tereza de Lira Benicio1, Ana Flávia Tibúrcio Ribeiro2, Andre D Américo1, Felipe M Furtado1, Ana B Glória3, Aleide S Lima4, Silvana M Santos5, Sandra G Xavier5, Antonio R Lucena-Araujo4, Evandro M Fagundes3, Eduardo M Rego6. 1. Department of Internal Medicine, Medical School of Ribeirao Preto, Ribeirao Preto, Brazil. 2. Postgraduate Program in Pathology, Federal University of Minas Gerais, Belo Horizonte, Brazil; Hematology Unit, Federal University of Minas Gerais, Belo Horizonte, Brazil. 3. Hematology Unit, Federal University of Minas Gerais, Belo Horizonte, Brazil. 4. Department of Genetics, Federal University of Pernambuco, Recife, Brazil. 5. Department of Clinical Pathology, Federal University of Minas Gerais, Belo Horizonte, Brazil. 6. Department of Internal Medicine, Medical School of Ribeirao Preto, Ribeirao Preto, Brazil; Center for Cell Based Therapy, University of Sao Paulo, Ribeirao Preto, Brazil. Electronic address: emrego@hcrp.usp.br.
Abstract
BACKGROUND: Current results regarding treatment outcomes in acute myeloid leukemia (AML) point to significant differences between low- and middle-income countries (LMIC) and high-income countries (HIC). Excluding well-known socioeconomic issues, genetic markers important for prognosis have not been properly incorporated into the clinical practice so far and their usefulness outside of well-controlled clinical trials remain unknown. METHODS: Here, we assessed the clinical significance of the European LeukemiaNet (ELN) recommendations in 196 consecutive patients with AML in a real-life setting. All patients were younger than 60 years of age (49% male) and treated with conventional chemotherapy for induction and consolidation in three Brazilian Institutions that well represent Brazilian geographic and socioeconomic diversity. FINDINGS: Multivariable analysis showed that ELN recommendations had a slight association with complete remission achievement (odds ratio: 0.74, 95% confidence interval, CI: 0.53-1.01; P=0.06), but were independently associated with poor overall survival (OS) (hazard ratio, HR: 1.3, 95% CI: 1.1-1.54; P=0.002), disease-free survival (DFS) (HR: 1.42, 95% CI: 1.03-1.95; P=0.028) and event-free survival (EFS) (HR: 1.24, 95% CI: 1.06-1.47; P=0.007), considering initial leukocyte counts and age as confounders. ELN recommendations had no impact on cumulative incidence of relapse (P=0.09). INTERPRETATION: Our results suggest that within the context of LMIC, the prognostic markers recommended by ELN may be useful to predict patient's clinical outcomes; however, the OS, DFS and EFS were shorter than the reported in Europe and US for the respective risk groups.
BACKGROUND: Current results regarding treatment outcomes in acute myeloid leukemia (AML) point to significant differences between low- and middle-income countries (LMIC) and high-income countries (HIC). Excluding well-known socioeconomic issues, genetic markers important for prognosis have not been properly incorporated into the clinical practice so far and their usefulness outside of well-controlled clinical trials remain unknown. METHODS: Here, we assessed the clinical significance of the European LeukemiaNet (ELN) recommendations in 196 consecutive patients with AML in a real-life setting. All patients were younger than 60 years of age (49% male) and treated with conventional chemotherapy for induction and consolidation in three Brazilian Institutions that well represent Brazilian geographic and socioeconomic diversity. FINDINGS: Multivariable analysis showed that ELN recommendations had a slight association with complete remission achievement (odds ratio: 0.74, 95% confidence interval, CI: 0.53-1.01; P=0.06), but were independently associated with poor overall survival (OS) (hazard ratio, HR: 1.3, 95% CI: 1.1-1.54; P=0.002), disease-free survival (DFS) (HR: 1.42, 95% CI: 1.03-1.95; P=0.028) and event-free survival (EFS) (HR: 1.24, 95% CI: 1.06-1.47; P=0.007), considering initial leukocyte counts and age as confounders. ELN recommendations had no impact on cumulative incidence of relapse (P=0.09). INTERPRETATION: Our results suggest that within the context of LMIC, the prognostic markers recommended by ELN may be useful to predict patient's clinical outcomes; however, the OS, DFS and EFS were shorter than the reported in Europe and US for the respective risk groups.
Authors: Antonio R Lucena-Araujo; Juan L Coelho-Silva; Diego A Pereira-Martins; Douglas R Silveira; Luisa C Koury; Raul A M Melo; Rosane Bittencourt; Katia Pagnano; Ricardo Pasquini; Elenaide C Nunes; Evandro M Fagundes; Ana B Gloria; Fábio Kerbauy; Maria de Lourdes Chauffaille; Israel Bendit; Vanderson Rocha; Armand Keating; Martin S Tallman; Raul C Ribeiro; Richard Dillon; Arnold Ganser; Bob Löwenberg; P J M Valk; Francesco Lo-Coco; Miguel A Sanz; Nancy Berliner; Eduardo M Rego Journal: Blood Date: 2019-07-10 Impact factor: 22.113
Authors: Douglas R A Silveira; Lynn Quek; Itamar S Santos; Anna Corby; Juan L Coelho-Silva; Diego A Pereira-Martins; Grant Vallance; Benjamin Brown; Luciana Nardinelli; Wellington F Silva; Elvira D R P Velloso; Antonio R Lucena-Araujo; Fabiola Traina; Andy Peniket; Paresh Vyas; Eduardo M Rego; Israel Bendit; Vanderson Rocha Journal: Blood Adv Date: 2020-05-26