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. 2022 Mar 31;57(1):29-33.
doi: 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?

Sergio I Inclan-Alarcon  1 , Santiago Riviello-Goya  1 , Kevin Teran-De-la-Sancha  1 , Oscar M Fierro-Angulo  2 , Aldo A Acosta-Medina  1 , Roberta Demichelis-Gomez  1 , Christianne Bourlon  1
Affiliations

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?

Sergio I Inclan-Alarcon et al. Blood Res. .

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.

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

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Conflict of interest statement

Authors’ Disclosure of Potential Conflict of Interest

No potential conflicts of interest relevant to this article were reported.

Figures

Fig. 1
Fig. 1
Cumulative mortality risk related to (A) central nervous system status and (B) dialysis requirement.
See this image and copyright information in PMC

References

    1. Terwilliger T, Abdul-Hay M. Acute lymphoblastic leukemia: a comprehensive review and 2017 update. Blood Cancer J. 2017;7:e577. doi: 10.1038/bcj.2017.53. - DOI - PMC - PubMed
    1. Larson RA, Dodge RK, Burns CP, et al. A five-drug remission induction regimen with intensive consolidation for adults with acute lymphoblastic leukemia: cancer and leukemia group B study 8811. Blood. 1995;85:2025–37. doi: 10.1182/blood.V85.8.2025.bloodjournal8582025. - DOI - PubMed
    1. Wheeler K, Chessells JM, Bailey CC, Richards SM. Treatment related deaths during induction and in first remission in acute lymphoblastic leukaemia: MRC UKALL X. Arch Dis Child. 1996;74:101–7. doi: 10.1136/adc.74.2.101. - DOI - PMC - PubMed
    1. Ramos C, Rozen E, León M, et al. Results of treatment of acute lymphoblastic leukemia in two cohorts of Mexican patients. Rev Med Chil. 2011;139:1135–42. doi: 10.4067/S0034-98872011000900004. - DOI - PubMed
    1. Fernandes da Silva Junior W, Medina AB, Yamakawa PE, Buccheri V, Velloso EDRP, Rocha V. Treating adult acute lymphoblastic leukemia in Brazil-increased early mortality using a German multicenter acute lymphoblastic leukemia-based regimen. Clin Lymphoma Myeloma Leuk. 2018;18:e255–9. doi: 10.1016/j.clml.2018.03.001. - DOI - PubMed