Survival analysis of acute promyelocytic leukemia in a third-level hospital in Ecuador

INTRODUCTION.There is an important number of reports in Latin America, but there is a lack of data on acute promyelocytic leukemia (APL) in Ecuador., this is the main reason to carry out this study in the country, a disease that in recent decades has shown a significant improvement in survival.OBJECTIVES.To evaluate the overall survival (OS) and event-free survival (EFS), and also the demography, and the most relevant clinical and laboratorial findings.METHODS.We retrospectively reviewed the medical records of 48 patients with APL, diagnosed between January 2012 and December 2019.We collected the most relevant demographic, clinical and laboratorial characteristics, as well as data related to 30-day mortality, and 5 year-OS (overall survival) and EFS (event-free survival).RESULTS.Among the forty-eight (48) patients with acute promyelocytic leukemia, 44 patients received treatment, the mean number of days for the start of all trans retinoic acid (ATRA) and/or arsenic trioxide (ATO) was of 2.5 days from the moment of the diagnosis.60.4% of patients were classified as low risk and 39.5% as high risk, according to the national comprehensive cancer network (NCCN).The early death rate was 31.2%, the main cause of which was sepsis, multidrug resistant (MDR) bacterias were isolated in 83% of the patients who took blood cultures and died of early sepsis.after a median follow-up of 35 months only one patient relapsed.the five-year OS and EFS was 51.2%;In the multivariate analysis, only age was identified as an adverse prognostic factor.DISCUSSION.Compared to prospective trials with ATRA-based regimens, we found an inferior OS, mainly because of a high-rate early death.if we compare our findings with other real-world reports, we will also show inferior results probably explained by the high rate of early death due to infection by MDR batteries, in addition to the early deaths caused by hemorrhages.CONCLUSION.The low rate of OS shown in this study, could be improved based on changes to optimize the access of the patients to an early diagnosis and treatment and the reduction of the unacceptably high rates of multidrug resistance bacterial infections in our setting.