COMPARISON OF EARLY MORTALITY BETWEEN ACUTE MYELOID LEUCEMIA PATIENTS TREATED IN PUBLIC OR PRIVATE CENTERS: ANALYSIS FROM THE BRAZILIAN ACUTE MYELOID LEUKEMIA REGISTRY

Abstract

The Brazilian Acute Myeloid Leukemia Registry (RBLMA) is a recent initiative aimed at determining the clinical and epidemiological aspects of acute myeloid leukemia (AML) in Brazil. The full comprehension of our epidemiology and clinical outcomes are fundamental for guiding the best clinical practice since the majority of epidemiology data currently available came from abroad. In this setting, early mortality is a very useful parameter for evaluating the quality of healthcare in AML, with international data suggesting this rate could be as high as 20-30%. There are still few studies evaluating this parameter in Brazilian institutions, and to date, none have compared such mortality between public and private institutions. Objective: Assessment of early mortality rate on AML patients treated in public or private services. Secondary objectives include providing clinical and epidemiological data from the initial records of the RBLMA. Methods: This study enrolled patients from the Brazilian Acute Myeloid Leukemia Registry, a national ambispective study involving patients aged 18 years or older with a diagnosis AML (excluding acute promyelocytic leukemia and leukemias of ambiguous lineage) without previous treatment The study was supported by the Brazilian Association of Hematology, Hemotherapy, and Cellular Therapy (ABHH). Prognostic stratification followed the European Leukemia Net (ELN) 2022 guidelines. Results: 216 patients were analyzed, 56,5% (n = 122) from public health care and 43,5% (n = 94) from private health care. There was a slight prevalence of female cases (51,9% versus 48,1%) and the median age of diagnosis on public setting was 56 years versus 61 on private centers. The median Charlson's Comorbidity index on patients treated in public services was 1,0 versus 2,31 on patients from private centers. The early death, defined as as mortality within 30 days of the beginning of induction chemotherapy, was 27% in public services compared to 9.6% on patients from private setting, with an odds ratio for death of 3.5 (ci 95%, 1,5-7,7, p < .002). With a median follow-up of 18 months, the median overall survival (OS) of patients treated in public services was 4 months (CI 95%, 2,2-5,7) versus 22 months (CI 05%, 14,7 – 29,2) of patients treated in private services. The progression free survival (PFS) of patients from public or private centers was 4 months and 19 months, respectively. A multivariate analysis showed a hazard ratio for death of 4.12 (CI 95%, 2.35 - 7.23, p < .001) for patients treated on public services rather than private centers. Regarding the preferred treatment protocol, anthracyclines and cytarabine-based protocols represented the majority of prescribed treatments in the public setting (84,4% of treated patients), whereas in the private setting they represented 52,1% of treatments. Venetoclax-based treatment accounted for 43.6% of treatments in the private setting and only 1.6% at public centers. Conclusions: The difference in early mortality, OS, and PFS reflects an alarming disparity between AML patients treated in the public or private setting. Even with higher comorbidity index, patients treated in private services had better clinical outcomes and lower early mortality. The study provided an initial analysis of the epidemiological profile of patients with AML in Brazil and the preferred regimens used in each setting.