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Introduction <p>Early mortality (EM) in acute myeloid leukemia (AML) represents a significant challenge in middle-income countries. This study determined the 30-day and 60-day EM rates and identified independent prognostic factors at a Peruvian national reference center.</p> Methods <p>Retrospective cohort of 139 adults treated with 7 + 3 induction chemotherapy at the Hospital Nacional Edgardo Rebagliati Martins (2020–2024). Cox proportional hazards models were used to estimate adjusted hazard ratios (aHR).</p> Results <p>The 30-day and 60-day EM rates were 17.3% (24 deaths) and 24.5% (34 deaths), respectively, 79.4% of deaths were of infectious etiology. ICU admission was the strongest predictor of 30-day mortality (aHR 12.88; 95% CI 4.87–34.08), with a time-dependent effect attenuating beyond day 21. The post-induction complete remission (CR) rate was 54.0%; patients achieving CR had markedly superior survival (log-rank <i>p</i> &lt; 0.001). Age ≥ 60&#xa0;years was not an independent predictor of early death.</p> Conclusions <p>Early mortality substantially exceeds European benchmarks, driven primarily by infectious complications and clinical severity at presentation. ICU admission is a critical prognostic indicator; chronological age should not preclude intensive induction therapy.</p>

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Incidence, etiology, and predictors of early mortality after induction chemotherapy for aml in a middle-income country

  • 期刊论文

  • 发表日期：

    2026年7月7日

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  • Paulo Vizcardo,
  • Cesar Copaja-Corzo,
  • José Untama,
  • Javier Flores-Cohaila

摘要

Introduction

Early mortality (EM) in acute myeloid leukemia (AML) represents a significant challenge in middle-income countries. This study determined the 30-day and 60-day EM rates and identified independent prognostic factors at a Peruvian national reference center.

Methods

Retrospective cohort of 139 adults treated with 7 + 3 induction chemotherapy at the Hospital Nacional Edgardo Rebagliati Martins (2020–2024). Cox proportional hazards models were used to estimate adjusted hazard ratios (aHR).

Results

The 30-day and 60-day EM rates were 17.3% (24 deaths) and 24.5% (34 deaths), respectively, 79.4% of deaths were of infectious etiology. ICU admission was the strongest predictor of 30-day mortality (aHR 12.88; 95% CI 4.87–34.08), with a time-dependent effect attenuating beyond day 21. The post-induction complete remission (CR) rate was 54.0%; patients achieving CR had markedly superior survival (log-rank p < 0.001). Age ≥ 60 years was not an independent predictor of early death.

Conclusions

Early mortality substantially exceeds European benchmarks, driven primarily by infectious complications and clinical severity at presentation. ICU admission is a critical prognostic indicator; chronological age should not preclude intensive induction therapy.