{
  "abstract": "Background: Acute myeloid leukemia (AML) is an aggressive hematologic malignancy associated with high mortality. However, population-level real-world evidence describing AML treatment patterns in the Brazilian public healthcare system remains limited. We sought to characterize treatment patterns in patients with newly diagnosed (ND) AML, including first-line regimen intensity (intensive, non-intensive, or mixed). Methods: A retrospective cohort study was conducted using the NEXUS database. It links Brazil's national ambulatory and hospital claims systems (SIA/SIH DATASUS) and is mapped to the OMOP Common Data Model. Adults (≥18 years) with a first AML treatment claim between January 2019 and December 2023 were identified. Inclusion required ≥1 AML treatment claims and no prior AML treatment during a ≥12-month washout period, when available. Patients with treatment claims for acute promyelocytic leukemia (APL), non-AML acute leukemias and other cancers were excluded. Non-mandatory follow-up was extended to a minimum of 24 months per patient. Lines of therapy (LoT) were defined using a probabilistic algorithm applied to treatment claims. First-line regimens were classified as intensive, non-intensive, or mixed based on treatments received within 30 days of initiation. Outcomes included patient characteristics, LoT progression, treatment duration, medication use, and hematopoietic stem cell transplantation (HSCT) rates. Results: A total of 2,006 AML patients met all eligibility criteria (mean age 42.7 ± 15.5 years; 53.8% male; mean follow-up 3.8 ± 4.3 months). The number of cases varied from 426 in 2019 to 339 in 2023. Most patients (88.6%) had no major baseline comorbidities. HSCT was performed in 5.8% of patients (n=116), and only two patients (0.1%) had documented palliative care. Among 1,912 patients evaluable for LoT analysis, 13.6% (n=273) advanced to second-line (2L), 2.4% (n=48) to third-line (3L), and 0.5% (n=9) to fourth-line or more (4L+) therapy; 85.7% of patients ended after first-line treatment. Cytarabine was the most commonly used agent in all lines. In 1L, cytarabine (n=577) predominated, followed by cytarabine combined with daunorubicin (n=534). Azacitidine was the most frequent hypomethylating agent, observed from 1L through 3L. Classification of first-line regimen intensity showed that 26.3% (n=503) of patients received intensive regimens, 5.5% (n=105) non-intensive regimens, and 68.2% (n=1,304) mixed regimens. Novel targeted therapies (e.g., FLT3 or IDH inhibitors and venetoclax-based combinations) were not identified in this public-sector cohort. Conclusions: This study provides the first large-scale, population-level characterization of AML treatment patterns in the Brazilian public healthcare system. Conventional cytarabine-based regimens were the most frequent treatments across all lines of therapy, whereas novel targeted therapies were not identified. Most patients did not progress beyond first-line therapy and HSCT presented a low use. These findings suggest limited adoption of newer AML therapies and reinforce the value of real-world evidence to support healthcare planning, technology assessment, and future strategies to improve treatment access for patients with AML in Brazil.",
  "abstract_shown": true,
  "affiliations": [
    "Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil",
    "Johnson & Johnson Brazil, São Paulo, SP, Brazil",
    "Johnson & Johnson Mexico, Mexico",
    "Precision Data, São Paulo, SP, Brazil",
    "OncoClinicas, Belo Horizonte, MG, Brazil"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 7,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Eduardo REGO"
    },
    {
      "affs": [
        1
      ],
      "name": "Renato WATANABE DE OLIVEIRA"
    },
    {
      "affs": [
        2
      ],
      "name": "Monserrat ROJAS SOTELO"
    },
    {
      "affs": [
        1
      ],
      "name": "Simone FORNY"
    },
    {
      "affs": [
        3
      ],
      "name": "Caroline TIANEZE DE CASTRO"
    },
    {
      "affs": [
        3
      ],
      "name": "Vinicius GOULARTE-SILVA"
    },
    {
      "affs": [
        4
      ],
      "name": "Evandro MARANHÃO FAGUNDES"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/4wchcwj371yfb.bib",
  "cited_by": 0,
  "doi": "10.1016/j.htct.2026.107675",
  "fulltext_url": "http://www.sciencedirect.com/science/article/pii/S2531137926014227",
  "id": "4wchcwj371yfb",
  "issns": [
    "2531-1379",
    "2531-1387"
  ],
  "landing_url": "https://doi.org/10.1016/j.htct.2026.107675",
  "language": "en",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "lcc",
      "RC633-647.5"
    ],
    [
      "openalex",
      "2720|Acute Myeloid Leukemia Research"
    ]
  ],
  "openalex": "W7223138953",
  "pdf_url": null,
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-23",
  "publisher": "Elsevier",
  "ris": "https://research.draconitic.com/paper/4wchcwj371yfb.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T13:43:35Z",
      "native_id": "8e3f46fde75b438db7f48b9d8e885fe0",
      "source": "doaj",
      "url": "https://doi.org/10.1016/j.htct.2026.107675"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "lcc:RC633-647.5",
      "subfield": "endocrinology-metabolism"
    }
  ],
  "title": "REAL-WORLD TREATMENT PATTERNS OF ACUTE MYELOID LEUKEMIA (AML) IN THE BRAZILIAN PUBLIC HEALTHCARE SYSTEM: A RETROSPECTIVE COHORT STUDY USING NEXUS DATABASE, 2019–2023",
  "title_text": "REAL-WORLD TREATMENT PATTERNS OF ACUTE MYELOID LEUKEMIA (AML) IN THE BRAZILIAN PUBLIC HEALTHCARE SYSTEM: A RETROSPECTIVE COHORT STUDY USING NEXUS DATABASE, 2019–2023",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T13:43:35Z",
  "url": "https://research.draconitic.com/paper/4wchcwj371yfb",
  "venue": "Hematology, Transfusion and Cell Therapy",
  "versions": []
}