Survival Rates of Adults With Acute Lymphoblastic Leukemia in a Low-Income Population: A Decade of Experience at a Single Institution in Mexico.
The therapeutic progress for adults with acute lymphoblastic leukemia (ALL) has been slow, with a 5-year survival of 30% to 45% in developed countries. Scarce information is available regarding the treatment and survival rates from nonindustrialized populations. In the present study, the characteristics of adults with ALL at a single institution were documented.



The clinical files of patients aged ≥ 18 years who had been diagnosed with ALL from 2005 to 2015 at a reference center in Mexico were scrutinized. Overall survival (OS) and event-free survival (EFS) were determined using the Kaplan-Meier method. The hazard ratios for death and relapse were estimated using Cox regression analysis.



A total of 94 adults were included. Their median age was 33 years; 69 (73.4%) had high-risk and 25 (26.6%) had standard-risk ALL. Of the 94 patients, 67 (71.3%) achieved complete remission (CR), 20 (21.3%) experienced disease resistance, and 7 (7.4%) died early during induction to remission, mainly of sepsis. The 5-year EFS and OS was 23.4% and 31.1% for the whole group and 24.9% and 38.9% for patients who achieved CR, respectively. Of the 94 patients, 50 (43.9%) died of sepsis or disease progression. Relapse developed in 43 patients (45.7%). The median survival after relapse was 6.93 months. Bone marrow was the most frequent site of relapse (21 patients [48.8%]) and conferred a significantly lower 5-year OS of 16.4%.



Adults with ALL in Mexico had high-risk characteristics and an increased relapse rate; however, the OS after CR was similar to the greatest achieved in developed countries, suggesting that a threshold for curing adult ALL with current therapeutic strategies has been reached.
Department of Hematology, "Dr. José Eleuterio González" University Hospital, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico. Electronic address: carjaime@hotmail.com.
José Carlos
JC
Jaime-Pérez
Department of Hematology, "Dr. José Eleuterio González" University Hospital, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico.
Raúl Alberto
RA
Jiménez-Castillo
Department of Hematology, "Dr. José Eleuterio González" University Hospital, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico.
José Luis
JL
Herrera-Garza
Department of Hematology, "Dr. José Eleuterio González" University Hospital, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico.
Homero
H
Gutiérrez-Aguirre
Department of Hematology, "Dr. José Eleuterio González" University Hospital, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico.
Luis Javier
LJ
Marfil-Rivera
Department of Hematology, "Dr. José Eleuterio González" University Hospital, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico.
David
D
Gómez-Almaguer
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001853:Bone Marrow / Q000473:pathology; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008800:Mexico; D008875:Middle Aged; D011203:Poverty / Q000706:statistics & numerical data*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology; D011379:Prognosis; D016016:Proportional Hazards Models; D012008:Recurrence; D012074:Remission Induction / Q000379:methods; D015996:Survival Rate; D055815:Young Adult
D000970:Antineoplastic Agents
ALL in Latin America; ALL relapse; ALL survival; Adult acute lymphoblastic leukemia; Philadelphia chromosome in ALL