Treatment patterns and clinical outcomes in acute myeloid leukemia patients who are not eligible for intensive induction chemotherapy: A real-world study from Latin-America

Palabras clave: acute myeloid leukemia, real-world, treatment outcome, antimetabolites, antineoplastic, Latin America.


Introduction. There is a knowledge gap concerning patients with acute myeloid leukemia (AML) who are not eligible for intensive induction chemotherapy; this, together with a recent increase in the incidence in Latin America, encloses a need. Through real-world evidence, we describe and compare the results of the different treatment strategies within this context. Methodology. This is a longitudinal, descriptive, retrospective study of a cohort of Latin American patients with AML not eligible for intensive induction chemotherapy, treated with low-intensity chemotherapy or with the best supportive care alone between January 1, 2015, to December 31, 2018. Results. Of a total of 125 patients (median age 74.8 years), the majority received low-intensity chemotherapy (78.4%). The median time in months of overall survival (9.2), progression-free survival (4.8), and time to treatment failure (3.8) were longer in patients receiving hypomethylating agents. Additionally, better results were observed with low-intensity chemotherapy (complete response 11.2% and stable disease 17.3%) compared to the best supportive care alone. Conclusion. We deliver a real-world standpoint of Latin American patients with AML who are not eligible for intensive induction chemotherapy. Our findings pave the first steps of the way to describe, understand, and support informed decision-making processes in our region.


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Biografía del autor/a

Kenny Mauricio Gálvez-Cárdenas, Hospital Pablo Tobón Uribe

Médico, Especialista en Medicina Interna, Especialista en Hematología, Hospital Pablo Tobón Uribe. Medellín, Colombia.

Leonardo José Enciso-Olivera, Instituto Nacional de Cancerología

Médico, Especialista en Hematología, Instituto Nacional de Cancerología. Bogotá, Colombia.

César Augusto Samanez-Figari, AUNA-Oncosalud

Médico, Especialista en Hematología, AUNA-Oncosalud. Lima, Perú.

Shirley Quintana-Truyenque, Instituto Nacional de Enfermedades Neoplásicas, INEN

Médica, Especialista en Oncología, Instituto Nacional de Enfermedades Neoplásicas, INEN. Lima, Perú.

Benito Arturo Castillo-Ríos, Instituto Oncológico de Panamá

Médico, Especialista en Hematología, Departamento Oncológico, Instituto Oncológico de Panamá. Ciudad de Panamá, Panamá.

Guillermo Enrique Quintero-Vega, Fundación Santa Fe de Bogotá

Médico, Especialista en Hematología, Fundación Santa Fe de Bogotá. Bogotá, Colombia.

Elizabeth Arrieta-López, Fundación Valle del Lili

Médica, Especialista en Hematología, Departamento de Hematología, Fundación Valle del Lili. Cali, Colombia.

Alexis Javier Pinto-Gómez, Hospitalario Dr. Arnulfo Arias Madrid, Centro Oncológico de Panamá, Hospital Santa Fe

Médico, Especialista en Hematología, Servicio de Hematología, Complejo Hospitalario Dr. Arnulfo Arias Madrid (CH-DrAAM), Centro Oncológico de Panamá (COPSA), Hospital Santa Fe. Ciudad de Panamá, Panamá.

Sandra Aruachan-Vesga, Clínica IMAT Oncomédica

Médica, Clínica IMAT Oncomédica. Montería, Colombia.

María Isabel Durán-Sánchez, AbbVie S.A.S

Médica, Especialista en Epidemiología, MSc en Ciencias Biológicas, AbbVie S.A.S. Bogotá, Colombia.

Germán Espino-Lopéz, Centro Hemato-Oncológico Panamá

Médico, Especialista en Hematología, Centro Hemato-Oncológico Panamá (CHOP). Ciudad de Panamá, Panamá.

Referencias bibliográficas

Döhner H, Weisdorf DJ, Bloomfield CD. Acute myeloid leukemia. N Engl J Med 2015;373:1136-1152.

American Cancer Society. Key statistics for acute myeloid leukemia (AML). Georgia, Estados Unidos: American Cancer Society; 2021. Available from

Dong Y, Shi O, Zeng Q, Lu X, Wang W, Li Y, et al. Leukemia incidence trends at the global, regional, and national level between 1990 and 2017. Exp Hematol Oncol 2020;9:14.

Yi M, Li A, Zhou L, Chu Q, Song Y, Wu K. The global burden and attributable risk factor analysis of acute myeloid leukemia in 195 countries and territories from 1990 to 2017: estimates based on the global burden of disease study 2017. J Hematol Oncol 2020;13:72.

United Nations (UN). World population ageing. New York, USA: United Nations, Department of Economic and Social Affairs; 2019. Available from

Ou Z, Yu D, Liang Y, He W, Li Y, Zhang M, et al. Analysis of the Global Burden of Disease study highlights the trends in death and disability-adjusted life years of leukemia from 1990 to 2017. Cancer Commun (Lond) 2020;40:598-610.

Bewersdorf JP, Shallis RM, Wang R, Huntington SF, Perreault S, Ma X, et al. Healthcare expenses for treatment of acute myeloid leukemia. Expert Rev Hematol 2019;12:641-650.

Gao L, Nguyen D, Lee P. A systematic review of economic evaluations for the pharmaceutical treatment of chronic lymphocytic leukemia and acute myeloid leukemia. Expert Rev Hematol 2022;15:833-847.

Tallman MS, Wang ES, Altman JK, Appelbaum FR, Bhatt VR, Bixby D, et al. Acute myeloid leukemia, version 3.2019, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2019;17:721-749.

Sekeres MA, Guyatt G, Abel G, Alibhai S, Altman JK, Buckstein R, et al. American Society of Hematology 2020 guidelines for treating newly diagnosed acute myeloid leukemia in older adults. Blood Adv 2020;4:3528-3549.

Jaime-Pérez JC, Ramos-Dávila EM, Picón-Galindo E, Jiménez-Castillo RA, León AG, Gómez-Almaguer D. Outcomes and survival predictors of Latin American older adults with acute myeloid leukemia: Data from a single center. Hematol Transfus Cell Ther 2022;25:S2531-1379(2522)00010-00014.

Griffiths EA, Carraway HE, Chandhok NS, Prebet T. Advances in non-intensive chemotherapy treatment options for adults diagnosed with acute myeloid leukemia. Leuk Res 2020;91:106339.

Döhner H, Estey E, Grimwade D, Amadori S, Appelbaum FR, Büchner T, et al. Diagnosis and management of AML in adults: 2017 ELN recommendations from an international expert panel. Blood 2017;129:424-447.

Wei AH, Montesinos P, Ivanov V, DiNardo CD, Novak J, Laribi K, et al. Venetoclax plus LDAC for newly diagnosed AML ineligible for intensive chemotherapy: a phase 3 randomized placebo-controlled trial. Blood 2020;135:2137-2145.

Wei AH, Strickland SA, Hou JZ, Fiedler W, Lin TL, Walter RB, et al. Venetoclax combined with low-dose cytarabine for previously untreated patients with acute myeloid leukemia: Results from a phase Ib/II study. J Clin Oncol 2019;37:1277-1284.

Abbvie Inc. Prescribing Information, VENCLEXTA® (venetoclax tablets) Approved by U.S. Food and Drug Administration. Illinois, USA: Abbvie Inc.; 2019. Available from

Jaime-Pérez JC, Brito-Ramirez AS, Pinzon-Uresti MA, Gutiérrez-Aguirre H, Cantú-Rodríguez OG, Herrera-Garza JL, et al. Characteristics and clinical evolution of patients with acute myeloblastic leukemia in northeast Mexico: an eight-year experience at a university hospital. Acta Haematol 2014;132:144-151.

Padilha SL, Souza EJ, Matos MC, Domino NR. Acute myeloid leukemia: survival analysis of patients at a university hospital of Paraná. Rev Bras Hematol Hemoter 2015;37:21-27.

Meillon-Garcia LA, Demichelis-Gómez R. Access to therapy for acute myeloid leukemia in the developing world: Barriers and solutions. Curr Oncol Rep 2020;22:125.

Vaughn JE, Shankaran V, Walter RB. Trends in clinical benefits and costs of novel therapeutics in aml: At what price does progress come? Curr Hematol Malig Rep 2019;14:171-178.

Medeiros BC, Pandya BJ, Hadfield A, Pike J, Wilson S, Mueller C, et al. Treatment patterns in patients with acute myeloid leukemia in the United States: a cross-sectional, real-world survey. Curr Med Res Opin 2019;35:927-935.

Zeidan AM, Wang R, Wang X, Shallis RM, Podoltsev NA, Bewersdorf JP, et al. Clinical outcomes of older patients with AML receiving hypomethylating agents: a large population-based study in the United States. Blood Advances 2020;4:2192-2201.

DiNardo CD, Pratz KW, Letai A, Jonas BA, Wei AH, Thirman M, et al. Safety and preliminary efficacy of venetoclax with decitabine or azacitidine in elderly patients with previously untreated acute myeloid leukaemia: a non-randomised, open-label, phase 1b study. The Lancet Oncology 2018;19:216-228.

Ma E, Bonthapally V, Chawla A, Lefebvre P, Swords R, Lafeuille MH, et al. An evaluation of treatment patterns and outcomes in elderly patients newly diagnosed with acute myeloid leukemia: A retrospective analysis of electronic medical records from US community oncology practices. Clin Lymphoma Myeloma Leuk 2016;16:625-636.e623.

Rodrigues AL, do Nascimento DM, de Lima JM, Reis ML, Leão LB, Azevedo MC, et al. Safety and feasibility of outpatient high dose cytarabine for acute myeloid leukemia in the Brazilian Amazon. Int J Hematol Oncol Stem Cell Res 2020;14:151-156.

Silveira DR, Coelho-Silva JL, Silva WF, Vallance G, Pereira-Martins DA, Madeira MI, et al. A multicenter comparative acute myeloid leukemia study: can we explain the differences in the outcomes in resource-constrained settings? Leuk Lymphoma 2021;62:147-157.

Díaz-Correa LM, Madrid-Muñoz CA, Combariza-Vallejo JF, Gálvez-Cárdenas KM, Olaya-Colorado V, Donado-Gómez JH. Supervivencia de los pacientes adultos con leucemia mieloide aguda en el departamento de hematología del Hospital Pablo Tobón Uribe entre los años 2004 y 2010. Rev Col Hematol Oncol 2017;4:40.

Lovato PE. Leucemia mieloide aguda en adultos: Estudio comparativo sobre tratamiento y pronóstico por grupos etarios. Revista Medica Herediana 2015;26:160-166.

Al-kassab-Córdova A, Lachira-Yparraguirre L, Sandival-Ampuero G, Roque K, Ortega E, Lozano-Ballena S, et al. Incidence and outcome of acute myeloid leukemia in Peru: An 11-year single center experience. Blood 2020;136:28-29.

Smith BD, Beach CL, Mahmoud D, Weber L, Henk HJ. Survival and hospitalization among patients with acute myeloid leukemia treated with azacitidine or decitabine in a large managed care population: a real-world, retrospective, claims-based, comparative analysis. Exp Hematol Oncol 2014;3:10.

Kumar AJ, Henzer T, Rodday AM, Parsons SK. Risk factors for length of stay and charge per day differ between older and younger hospitalized patients with AML. Cancer Med 2018;7:2744-2752.

Dombret H, Seymour JF, Butrym A, Wierzbowska A, Selleslag D, Jang JH, et al. International phase 3 study of azacitidine vs conventional care regimens in older patients with newly diagnosed AML with >30% blasts. Blood 2015;126:291-299.

Kanakasetty GB, Lakshmaiah KC, Dasappa L, Jacob LA, Suresh-Babu MC, Lokesh KN, et al. Treatment patterns and comparative analysis of non-intensive regimens in elderly acute myeloid leukemia patients-a real-world experience from India. Ann Hematol 2019;98:881-888.

Heiblig M, Le Jeune C, Elhamri M, Balsat M, Tigaud I, Plesa A, et al. Treatment patterns and comparative effectiveness in elderly acute myeloid leukemia patients (age 70 years or older): the Lyon-university hospital experience. Leuk Lymphoma 2017;58:110-117.

Fenaux P, Mufti GJ, Hellstrom-Lindberg E, Santini V, Finelli C, Giagounidis A, et al. Efficacy of azacitidine compared with that of conventional care regimens in the treatment of higher-risk myelodysplastic syndromes: a randomised, open-label, phase III study. Lancet Oncol 2009;10:223-232.

Kantarjian HM, Thomas XG, Dmoszynska A, Wierzbowska A, Mazur G, Mayer J, et al. Multicenter, randomized, open-label, phase III trial of decitabine versus patient choice, with physician advice, of either supportive care or low-dose cytarabine for the treatment of older patients with newly diagnosed acute myeloid leukemia. J Clin Oncol 2012;30:2670-2677.

Ministerio de Salud. Guía de Práctica Clínica. Leucemia mieloide aguda. Lima, Perú: Instituto Nacional de Enfermedades Neoplásicas; 2011. Available from

Ministerio de Salud y Protección Social. Guía de práctica clínica (GPC) para la detección, tratamiento y seguimiento de leucemias linfoblástica y mieloide en población mayor de 18 años. Guía No. GPC 2017-34. Bogotá D.C., Colombia: Ministerio de Salud y Protección Social; 2017. Available from

Qin Y, Kuang P, Liu T. Venetoclax combined with hypomethylating agents or low-dose cytarabine as induction chemotherapy for patients with untreated acute myeloid leukemia ineligible for intensive chemotherapy: a systematic review and meta-analysis. Clin Exp Med 2022;23:219-222.

Cómo citar
Gálvez-Cárdenas KM, Enciso-Olivera LJ, Samanez-Figari CA, Quintana-Truyenque S, Castillo-Ríos BA, Quintero-Vega GE, Arrieta-López E, Pinto-Gómez AJ, Aruachan-Vesga S, Durán-Sánchez MI, Espino-Lopéz G. Treatment patterns and clinical outcomes in acute myeloid leukemia patients who are not eligible for intensive induction chemotherapy: A real-world study from Latin-America. Med. Lab. [Internet]. 21 de septiembre de 2023 [citado 23 de mayo de 2024];27(4):315-32. Disponible en:
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