De novo acute myeloid leukemia in adults younger than 60 years of age: Socioeconomic aspects and treatment results in a Brazilian university center

Abstract

We retrospectively studied the outcomes of adults with de novo acute myeloid leukemia treated in a reference center in Brazil and analyzed the association with the human development index (HDI) of the United Nations used as a socioeconomic factor. Among 123 patients, 46 (37%) died during induction, 65 (53%) reached complete remission and 45 (37%) received high-dose cytarabine (Hidac) consolidation. The 5-year overall survival and leukemia-free survival (LFS) were 17 and 26%, respectively, for all patients and 36 and 30%, respectively, for those receiving Hidac. In multivariate analysis, an HDI <0.660 was associated with a lower probability to receive Hidac (P = 0.001), a trend for higher mortality in remission induction (P = 0.062) and a decreased LFS (P < 0.0001). However, it was not associated with outcomes for patients receiving Hidac. In conclusion, survival for patients who received Hidac consolidation is satisfactory; however, socioeconomic factors may have selected patients to receive intensive Hidac consolidation.

Clinical outcomes of patients with acute myeloid leukemia: evaluation of genetic and molecular findings in a real-life setting

“…Among the main reasons for high early mortality in Brazil, we highlight the lack of adequate hospital infrastructure, especially during induction therapy. 5,6 As a consequence, high incidence of bacterial and fungal infections are frequently reported. 7 It is important to note that our results are representative of a real-life setting, which strongly differs from the well-controlled clinical trials conducted in developing countries.…”

Relationships Between Percentage of Forest Coverage and Standardized Mortality Ratios (SMR) of Cancers in all Prefectures in Japan

“…Since smoking status influences the SMR of cancers (Mellemgaard et al, 1994;Mizoue et al, 2000;Minami and Tateno, 2003;Bjartveit and Tverdal, 2005;Toh et al, 2007;Ambrosone et al, 2008;Gong et al, 2008), especially for lung cancer (Minami and Tateno, 2003;Bjartveit and Tverdal, 2005;Toh et al, 2007), data on the smoking status in males and females in 2003 were also collected from the database of the Ministry of Health, Labour, and Welfare of Japan (Ministry of Health, Labour and Welfare of Japan, 2003). Since socioeconomic status is also a risk factor for cancers (Datta et al, 2006;Fagundes et al, 2006;Goy et al, 2008;Menvielle et al, 2008) we have to take it into account. The human development index (HDI) is a composite score used by the United Nations Development Programme to rank countries in terms of their human socioeconomic development status (Landry and Raman, 2007), which is a composite index of life expectancy, literacy, and per capita gross domestic product that measures the socioeconomic status of a country (Lee et al, 1997).…”

“…As shown in Tables 2a and b, there were still significant inverse relationships between the percentage of forest coverage and SMR of lung (r=-0.304, p<0.05) and breast (r=-0.312, p<0.05) cancers in females, and SMR of prostate (r=-0.309, p<0.05), kidney (r=-0.342, p<0.05), and colon cancers (r=-0.293, p=0.05) in males after the effect of smoking was factored in. Socioeconomic status also affects the mortality rate due to cancers (Datta et al, 2006;Fagundes et al, 2006;Goy et al, 2008;Menvielle et al, 2008), and HDI has been used to evaluate the socioeconomic status of countries (Landry and Raman, 2007). We further calculated the partial correlation coefficients between the percentage of forest coverage and SMR of cancers after the effect of socioeconomic status (HDI) was factored in.…”

Characterization and analysis of the outcome of adults with acute myeloid leukemia treated in a Brazilian University hospital over three decades

“…However, while randomized clinical trials have reported high long-term survival rates, the results of population-based studies have shown long-term remissions in a quarter of patients only (4)(5)(6)(7). Furthermore, retrospective studies performed in developing countries have reported even lower overall survival rates (8)(9)(10)(11)(12)(13).…”