María Manuela Clavijo, Juan Ignacio Ruiz, Luciana Ferrari, Alberto Gimenez Conca, Agostina Delorenzi, Leticia Rapan, Nicolas Cazap, María Marta Rivas, Eliana Moya, Lucía Agamennoni, Celina Guadalupe Vega, Julian Freue, Maria Eugenia Funes, Hernan Daniel Dick, Mercedes Mac Mullen, Alicia Navickas, Isolda Fernandez, Natalia Carnelutto, Claudia Vicente, María Moirano, Ana Lisa Basquiera, Carolina Belli
In this acute lymphoblastic leukemia Argentinean cohort, overall survival was influenced by classical predictors of a worse outcome and by healthcare disparities. Receiving treatment at public institutions adversely diminished access to first-line allogeneic stem cell transplantation, which may account for the poorer outcome.
INTRODUCTION: Data on clinical outcomes and allogeneic stem cell transplantation for Latin American Philadelphia chromosome-negative acute lymphoblastic leukemia patients are limited. This study aimed to characterize this population and identify factors influencing overall survival among adolescents and adults with this malignancy in Argentina. Additionally, the study examined the predictors of proceeding to first-line allogeneic stem cell transplantation in this population.
METHODS: This retrospective cohort study included patients diagnosed at 15 centers between 2014 and 2022. Descriptive, univariate, and multivariate analyses were conducted.
RESULTS: Three hundred and five patients with a median age of 34 years were included. Median overall survival was 42 months. Treatment at public healthcare institutions (hazard ratio: 1.61), central nervous system involvement (hazard ratio: 1.56), high-risk status defined by the receipt of Berlin-Frankfurt-Münster-like or hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone (hyper-CVAD) regimens (hazard ratio: 1.89), and older age (hazard ratio: 1.02) were independently associated with a worse outcome. In a subgroup analysis of 199 patients with an indication and eligibility to receive allogeneic stem cell transplantation, 20.1% underwent the procedure. Receiving treatment at public institutions was associated with a 65% lower likelihood of undergoing transplantation (p-value = 0.013), an effect that remained consistent when death or relapse was accounted for as a competing event (Subdistribution Hazard Ratio: 0.28).
CONCLUSIONS: In this acute lymphoblastic leukemia Argentinean cohort, overall survival was influenced by classical predictors of a worse outcome and by healthcare disparities. Receiving treatment at public institutions adversely diminished access to first-line allogeneic stem cell transplantation, which may account for the poorer outcome.