Blood Res.  2022 Mar;57(1):29-33. 10.5045/br.2021.2021058.

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?

• Inclan-Alarcon SI
• Riviello-Goya S
• Teran-De-la-Sancha K
• Fierro-Angulo OM
• Acosta-Medina AA
• Demichelis-Gomez R
• Bourlon C

• KMID: 2527494
• DOI: http://doi.org/10.5045/br.2021.2021058

Abstract

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.

Keyword

Risk factors; Treatment outcome; Chemotherapy induced mortality; Precursor cell lymphoblastic leukemia-lymphoma; Developing countries

Figure

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  Fig. 1 Cumulative mortality risk related to (A) central nervous system status and (B) dialysis requirement.

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