Análisis de supervivencia de pacientes con leucemia mieloide aguda no promielocítica de novo en un hospital de tercer nivel en Ecuador

INTRODUCTION: There are a significant number of reports in Latin America, but there are no survival data on acute myeloid leukemia (AML) in Ecuador, so it is important to report the first survival analysis in patients with de novo AML in a reference center in the country. OBJECTIVES: To evaluate overall survival (OS), relapse-free survival (RFS) and risk factors associated with survival, as well as to describe the most relevant clinical and laboratory characteristics at presentation. METHODS: We retrospectively reviewed the medical records of 121 patients ≥ 15 years old, with de novo AML candidates for intensive chemotherapy, diagnosed between January 2012 and December 2019 and followed up until December 2021, and a survival analysis (OS and RFS at 5 years) was performed. For the description of the most relevant clinical and laboratory characteristics at presentation, 260 medical records were reviewed, including patients who were not candidates for intensive chemotherapy, those who died before receiving treatment, those who did not wish to receive chemotherapy, secondary AML, or those who were referred to other centers for treatment. RESULTS: Of the 121 patients who received intensive chemotherapy, 22.3% died during induction chemotherapy, with 74% of deaths related to multidrug-resistant (MDR) bacteria. The overall treatment-related mortality was 29.7%. The complete response (CR) rate was 54.9% with the first induction in all patients, while in patients ≤ 60 years treated with a 7+3 induction regimen, the CR rate was 79.5%. 12.7% of patients were considered primary refractory. The average number of days between each chemotherapy cycle, including the consolidation phase, was 50.2 days. The 5-year OS was 12.2% (median survival of 8 months) and in patients who received 7+3 induction protocol the 5-year OS was 13.3% (median survival of 8 months). The 5-year RFS was 21.2% (median survival of 13 months). In the multivariate analysis, the adapted intermediate-risk cytogenetics group showed an association with OS, HR of 0.47 (P 0.036). No patient in this cohort had access to hematopoietic stem cell transplantation. CONCLUSION: The very low OS rates are directly affected by the high mortality associated with treatment in the context of MDR bacterial infections as well as a serious problem of access to bone marrow transplantation, which makes the OS in this study even lower than the Latin American average.