HSCT ACESSIBILITY AND SURVIVAL OUTCOMS IN PATIENTS WITH ALL AND AML IN A DEVELOPING COUNTRY
- 1Faculdade Evangélica Mackenzie do Paraná, Curitiba, PR, Brazil
Abstract
Introduction: Allogeneic hematopoietic stem cell transplant (HSCT) is a curative treatment option for selected patients with acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL). Bigger intervals between diagnosis and HSCT realization are associated with higher relapse rates and treatment-related toxicities, while a waiting time of less than 3 months is associated with higher survival following HSCT. In Brazil, access to HSCT is impacted not only by the severity of the underlying disease and donor availability, but also by the availability of HSCT specific beds in a hematology ward. Objectives: To evaluate HSCT accessibility and survival outcomes in patients with ALL and AML in a developing country. Method: A retrospective, observational, analytical study conducted in a public tertiary care center in Brazil between 2019 and 2024, evaluating demographics, clinical and laboratory parameters, the time interval between disease remission and HSCT date and survival outcomes of 85 adult patients with ALL and AML. Inclusion criteria was determined by > 20% blasts; > 10% blasts with complex cytogenetics; or > 20% immature monocytic cells with the presence of blasts in the bone marrow or peripheral blood. Transplant eligibility was defined by < 65 lt; 65 years of age, an Eastern Cooperative Oncology Group performance status ≤ 2 and one of the following: high-risk stratification at diagnosis, relapsed/refractory leukemia, or intermediate-risk AML with an available donor. Survival analyses used Kaplan-Meier estimates. Results: Out of 85 patients (18 with ALL and 67 with AML), 48 met the criteria for HSCT eligibility: 29 due to high-risk stratification at diagnosis, 7 due to relapsed/refractory leukemia and 11 due to intermediate-risk AML with an available donor. Of these, 20 ultimately underwent HSCT. Reasons for not proceeding to transplantation included death (n = 14), relapse (n = 5), lack of a suitable donor (n = 2), patient choice (n = 2), and withdrawal of the indication by the HSCT center (n = 1). 11 out of 14 patients died from infection, while the other died 3 from disease progression following relapse. Follow-up was lost for 4 patients, and data as to why they did not reach HSCT were unavailable. The interval between complete remission and transplantation was available for 11 patients and ranged from 1.8- to 18.3-months, with a median waiting time of 7.43-months. Conclusions: Leukemia treatment weakens patients' overall condition and increases their vulnerability, which is exacerbated by longer intervals between diagnosis and HSCT, due to the need for additional lines of therapy while patients await transplantation. This results in healthcare costs, including those related to maintaining patients’ quality of life, treating infections, providing transfusion support and administering salvage therapies. In the present study, a marked discrepancy was observed between the number of patients with an indication for HSCT and those who ultimately underwent transplantation. Death was the leading reason for failure to proceed to HSCT, followed by disease relapse, underscoring the impact of prolonged waiting times on treatment-related morbidity and leukemia progression. These findings highlight the burden on Brazil's public healthcare system and the challenges in ensuring timely access to transplantation. However, as this is a single-center study, larger multicenter studies are needed to provide a more comprehensive assessment of access to HSCT in Brazil.
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BibTeX
@article{biasi2026hsct,
title = {{HSCT ACESSIBILITY AND SURVIVAL OUTCOMS IN PATIENTS WITH ALL AND AML IN A DEVELOPING COUNTRY}},
author = {João Pedro Greca de Macedo BIASI and Júlia Riedel DERETI and Inácio Skraba SILVA and Maurício LITTIERI and Fabíola Pabst BREMER},
journal = {Hematology, Transfusion and Cell Therapy},
year = {2026},
month = oct,
doi = {10.1016/j.htct.2026.108486},
url = {https://doi.org/10.1016/j.htct.2026.108486},
note = {CC BY},
}
RIS
TY - JOUR
TI - HSCT ACESSIBILITY AND SURVIVAL OUTCOMS IN PATIENTS WITH ALL AND AML IN A DEVELOPING COUNTRY
AU - João Pedro Greca de Macedo BIASI
AU - Júlia Riedel DERETI
AU - Inácio Skraba SILVA
AU - Maurício LITTIERI
AU - Fabíola Pabst BREMER
PY - 2026
DA - 2026/10/23
JO - Hematology, Transfusion and Cell Therapy
DO - 10.1016/j.htct.2026.108486
UR - https://doi.org/10.1016/j.htct.2026.108486
AB - Introduction: Allogeneic hematopoietic stem cell transplant (HSCT) is a curative treatment option for selected patients with acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL). Bigger intervals between diagnosis and HSCT realization are associated with higher relapse rates and treatment-related toxicities, while a waiting time of less than 3 months is associated with higher survival following HSCT. In Brazil, access to HSCT is impacted not only by the severity of the underlying disease and donor availability, but also by the availability of HSCT specific beds in a hematology ward. Objectives: To evaluate HSCT accessibility and survival outcomes in patients with ALL and AML in a developing country. Method: A retrospective, observational, analytical study conducted in a public tertiary care center in Brazil between 2019 and 2024, evaluating demographics, clinical and laboratory parameters, the time interval between disease remission and HSCT date and survival outcomes of 85 adult patients with ALL and AML. Inclusion criteria was determined by > 20% blasts; > 10% blasts with complex cytogenetics; or > 20% immature monocytic cells with the presence of blasts in the bone marrow or peripheral blood. Transplant eligibility was defined by < 65 lt; 65 years of age, an Eastern Cooperative Oncology Group performance status ≤ 2 and one of the following: high-risk stratification at diagnosis, relapsed/refractory leukemia, or intermediate-risk AML with an available donor. Survival analyses used Kaplan-Meier estimates. Results: Out of 85 patients (18 with ALL and 67 with AML), 48 met the criteria for HSCT eligibility: 29 due to high-risk stratification at diagnosis, 7 due to relapsed/refractory leukemia and 11 due to intermediate-risk AML with an available donor. Of these, 20 ultimately underwent HSCT. Reasons for not proceeding to transplantation included death (n = 14), relapse (n = 5), lack of a suitable donor (n = 2), patient choice (n = 2), and withdrawal of the indication by the HSCT center (n = 1). 11 out of 14 patients died from infection, while the other died 3 from disease progression following relapse. Follow-up was lost for 4 patients, and data as to why they did not reach HSCT were unavailable. The interval between complete remission and transplantation was available for 11 patients and ranged from 1.8- to 18.3-months, with a median waiting time of 7.43-months. Conclusions: Leukemia treatment weakens patients' overall condition and increases their vulnerability, which is exacerbated by longer intervals between diagnosis and HSCT, due to the need for additional lines of therapy while patients await transplantation. This results in healthcare costs, including those related to maintaining patients’ quality of life, treating infections, providing transfusion support and administering salvage therapies. In the present study, a marked discrepancy was observed between the number of patients with an indication for HSCT and those who ultimately underwent transplantation. Death was the leading reason for failure to proceed to HSCT, followed by disease relapse, underscoring the impact of prolonged waiting times on treatment-related morbidity and leukemia progression. These findings highlight the burden on Brazil's public healthcare system and the challenges in ensuring timely access to transplantation. However, as this is a single-center study, larger multicenter studies are needed to provide a more comprehensive assessment of access to HSCT in Brazil.
SN - 2531-1379
SN - 2531-1387
ER -