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KMID : 1142020220570010029
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Blood Research
2022 Volume.57 No. 1 p.29 ~ p.33
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Induction-related mortality in adolescents and young adults with acute lymphoblastic leukemia in a resource-limited setting: do treatment-related complications create more impact than disease biology?
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Inclan-Alarcon Sergio I.
Riviello-Goya Santiago
Teran-De-la-Sancha Kevin
Fierro-Angulo Oscar M.
Acosta-Medina Aldo A.
Demichelis-Gomez Roberta
Bourlon Christianne
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Abstract
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Background: Acute lymphoblastic leukemia (ALL) is a malignant clonal bone marrow disorder with a high mortality rate during the initial therapy. This retrospective study aimed to describe and analyze the risk factors and causes of induction-related mortality (IRM) in an adolescent and adult ALL population treated in a low- and middle-income country.
Methods: From 2009 to 2016, a total of 167 patients were included, of which 50.9% were male with a median age of 28 years. B-immunophenotype represented 97.6%, and high-risk cytogenetics were present in 23.3%. During induction therapy, 91% had at least 1 complication, most of which were infectious, with an IRM of 12%.
Results: Factors associated with increased mortality rate were central nervous system (CNS) status [CNS-3: hazard ratio (HR) 3.029; 95% confidence interval (CI), 0.79?11.49; P =0.103 and CNS-2: HR, 9.98; 95% CI, 2.65?37.65; P =0.001] and dialysis requirement (HR, 9.15; 95% CI, 2.44?34.34; P =0.001).
Conclusion: Our study confirms that ALL patients treated in resource-constrained settings have high rates of IRM, mainly attributed to advanced disease and high tumor burden at diagnosis.
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KEYWORD
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Risk factors, Treatment outcome, Chemotherapy induced mortality, Precursor cell lymphoblastic leukemia-lymphoma, Developing countries
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