The treatment of acute myeloid leukemia in Brazil: progress and obstacles.
BACKGROUND
Substantial progress has been made in the treatment of acute myeloid leukemia in the last two decades. We wanted to evaluate the outcome of intensive chemotherapy and the influence of recent therapy changes in underprivileged patients treated in a large urban public university hospital.


METHODS
The records of all patients treated for acute myeloid leukemia from 1980 to 1993 were analyzed.


RESULTS
109 patients were identified; 41 did not receive any treatment for the leukemia because of infectious and/or hemorrhagic complications of advanced disease. Median survival in this group was 4 days. The other 68 patients received one of two induction protocols: TAD from 1980 to 1985 (n = 23) and ara-C plus daunorubicin from 1985 to 1992 (n = 45). The complete remission rate was 56%, disease-free survival 24% and overall survival 15% at 13 years. Overall survival was better for patients treated with ara-C plus daunorubicin than with TAD (19% versus 8%, p = 0.01). This is attributed to a reduction in infection mortality after ceftazidime and amikacin replaced cephalotin, carbenicillin and amikacin as the antibiotic regimen.


CONCLUSIONS
The most effective intervention in our population would probably be an improvement in the primary health care system, so that earlier diagnosis could allow the treatment of a larger fraction of patients.
Pulcheri
W
W
Hematology Service, University Hospital, Federal University of Rio de Janeiro, Brazil.
Spector
N
N
Nucci
M
M
de Morais
J C
JC
Pimenta
G
G
de Oliveira
H P
HP
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000583:Amikacin / Q000627:therapeutic use; D000616:Aminoglutethimide / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016913:Blood Component Transfusion; D001938:Brazil / Q000453:epidemiology; D002228:Carbenicillin / Q000627:therapeutic use; D002442:Ceftazidime / Q000627:therapeutic use; D002512:Cephalothin / Q000627:therapeutic use; D003561:Cytarabine / Q000008:administration & dosage; D003613:Danazol / Q000008:administration & dosage; D003630:Daunorubicin / Q000008:administration & dosage; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D017053:Infection Control; D007951:Leukemia, Myeloid / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D012074:Remission Induction; D016879:Salvage Therapy; D016019:Survival Analysis; D013629:Tamoxifen / Q000008:administration & dosage; D016896:Treatment Outcome
D003561:Cytarabine; D013629:Tamoxifen; D000616:Aminoglutethimide; D004317:Doxorubicin; D000583:Amikacin; D002442:Ceftazidime; D002228:Carbenicillin; D003613:Danazol; D002512:Cephalothin; D003630:Daunorubicin