Blood Res 2022; 57(1):
Published online March 31, 2022
https://doi.org/10.5045/br.2021.2021058
© The Korean Society of Hematology
Correspondence to : Christianne Bourlon, M.D.
Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez Sección XVI, Tlalpan, Mexico City 14080, Mexico
E-mail: chrisbourlon@hotmail.com
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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.
Keywords Risk factors, Treatment outcome, Chemotherapy induced mortality, Precursor cell lymphoblastic leukemia-lymphoma, Developing countries
Blood Res 2022; 57(1): 29-33
Published online March 31, 2022 https://doi.org/10.5045/br.2021.2021058
Copyright © The Korean Society of Hematology.
Sergio I. Inclan-Alarcon1, Santiago Riviello-Goya1, Kevin Teran-De-la-Sancha1, Oscar M. Fierro-Angulo2, Aldo A. Acosta-Medina1, Roberta Demichelis-Gomez1, Christianne Bourlon1
1Department of Hematology and Oncology, 2Department of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
Correspondence to:Christianne Bourlon, M.D.
Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez Sección XVI, Tlalpan, Mexico City 14080, Mexico
E-mail: chrisbourlon@hotmail.com
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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.
Keywords: Risk factors, Treatment outcome, Chemotherapy induced mortality, Precursor cell lymphoblastic leukemia-lymphoma, Developing countries
Table 1 . Patients baseline characteristics grouped by AYA and non-AYA..
Characteristics | AYA (N=112) | Non-AYA (N=55) |
---|---|---|
Male sex, N (%) | 59 (52.7) | 26 (47.3) |
Age, median (range) | 22 (16–39) | 51 (40–70) |
Socioeconomic status, N (%) | ||
Low-income | 111 (99.1) | 47 (85.5) |
Middle-income | 0 (0) | 3 (5.4) |
High-income | 1 (0.9) | 5 (9.1) |
ECOG ≤2, N (%) | 109 (97.3) | 52 (94.5) |
Comorbidities, N (%) | 45 (40.2) | 36 (65.5) |
DM | 2 (1.8) | 15 (27.3) |
HTN | 4 (3.6) | 9 (16.4) |
Obesity | 21 (18.8) | 15 (27.3) |
ALL phenotype, N (%) | ||
B-cell leukemia | 109 (97.3) | 54 (98.2) |
Pre-B | 102 (93.6) | 54 (100) |
Mature B | 6 (5.5) | 0 (0) |
Pro-B | 1 (0.9) | 0 (0) |
T-cell leukemia | 3 (2.7) | 1 (1.8) |
Cytogenetic abnormalitiesa), N (%) | 28 (25.5) | 20 (38.5) |
Philadelphia chromosome | 17 (15.5) | 12 (23.1) |
MLL rearrangements | 1 (0.9) | 1 (1.9)c) |
Hypodiploidy | 0 (0) | 2 (3.9) |
Complex karyotype | 5 (4.6)b) | 1 (1.9) |
Others | 8 (7.3) | 5 (9.6) |
CNS involvement, N (%) | 13 (11.6) | 6 (10.9) |
a)Cases with available cytogenetics: AYA (N=110) and Non-AYA (N=52). b)Two patients Ph+ and one with
Abbreviations: ALL, acute lymphoblastic leukemia; AYA, adolescent and young adult; CNS, central nervous system; DM, diabetes mellitus; ECOG, Eastern Cooperative Oncology Group; HTN, hypertension; MLL, mixed-lineage leukemia; Ph+, Philadelphia positive..
Table 2 . Induction-related complications..
Complications | N=152 |
---|---|
Infectious, N (%) | 146 (87.4) |
Bloodstream infection | 45 (30.8) |
UTI | 23 (15.8) |
Pneumonia | 55 (37.7) |
Skin and soft tissue | 33 (22.6) |
10 (6.9) | |
IFI | 29 (19.9) |
Metabolic, N (%) | 70 (46.1) |
Hipertransaminasemia | 22 (31.4) |
Dialysis requirement | 7 (10.0) |
TLS | 41 (58.6) |
Hematologic, N (%) | 18 (11.8) |
Hemorrhage | 5 (27.8) |
Thrombosis | 7 (38.9) |
DIC | 6 (33.3) |
Abbreviations: DIC, disseminated intravascular coagulation; IFI, invasive fungal infections; TLS, tumor lysis syndrome; UTI, urinary tract infection..
Table 3 . Factors related to a decreased overall survival after induction..
Univariate analysis OS day+60 (%) | Multivariate analysis HR (95% CI) | |||
---|---|---|---|---|
Central nervous system involvement | CNS-3: 3.078 (0.81–11.67) | 0.09 | ||
CNS-3 vs. CNS-2 vs. CNS-1 | 73.7% vs. 37.5% vs. 92.7% | <0.001 | CNS-2: 10.10 (2.67–38.18) | 0.001 |
TLS | 75.3% vs. 85.12% | 0.005 | - | - |
DIC | 66.7% vs. 89.4% | 0.037 | - | - |
Shock | 63.2% vs. 93.8% | <0.001 | - | - |
Bloodstream infection | 83.1% vs. 95.3% | 0.020 | - | - |
Dialysis requirement | 28.6% vs. 91.0% | <0.001 | 9.224 (2.45P33.72) | 0.001 |
Abbreviations: CNS, central nervous system; DIC, disseminated intravascular coagulation; OS, overall survival; TLS, tumor lysis syndrome..
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