TREATMENT ACCESSIBILITY AND OVERALL SURVIVAL OF ADULTS WITH ACUTE LYMPHOBLASTIC LEUKEMIA WITHIN BRAZIL’S PUBLIC HEALTH SYSTEM

@article{dereti2026treatment,
  title = {{TREATMENT ACCESSIBILITY AND OVERALL SURVIVAL OF ADULTS WITH ACUTE LYMPHOBLASTIC LEUKEMIA WITHIN BRAZIL’S PUBLIC HEALTH SYSTEM}},
  author = {Julia RIEDEL DERETI and João Pedro GRECA DE MACEDO BIASI and Fabiola PABST BREMER and Maurício LITTIERI},
  journal = {Hematology, Transfusion and Cell Therapy},
  year = {2026},
  month = oct,
  doi = {10.1016/j.htct.2026.108537},
  url = {https://doi.org/10.1016/j.htct.2026.108537},
  note = {CC BY},
}

TY  - JOUR
TI  - TREATMENT ACCESSIBILITY AND OVERALL SURVIVAL OF ADULTS WITH ACUTE LYMPHOBLASTIC LEUKEMIA WITHIN BRAZIL’S PUBLIC HEALTH SYSTEM
AU  - Julia RIEDEL DERETI
AU  - João Pedro GRECA DE MACEDO BIASI
AU  - Fabiola PABST BREMER
AU  - Maurício LITTIERI
PY  - 2026
DA  - 2026/10/23
JO  - Hematology, Transfusion and Cell Therapy
DO  - 10.1016/j.htct.2026.108537
UR  - https://doi.org/10.1016/j.htct.2026.108537
AB  - Introduction: Adult B-cell acute lymphoblastic leukemia (B-ALL) remains a challenging hematologic malignancy, particularly in patients with high-risk or relapsed/refractory disease. Advances in targeted and immunotherapeutic approaches have improved outcomes, but access to these therapies remains limited in some healthcare settings. Objectives: To evaluate treatment accessibility and survival outcomes in adult patients diagnosed with ALL treated by Brazil's public health system (SUS). Method: A retrospective, observational, analytical cohort study evaluating demographics, clinical and laboratory parameters, and survival outcomes via descriptive statistics. Conducted in a single tertiary care center in Brazil, between 2019 and 2024. The analysis included 18 adult ALL patients. Inclusion required > 20% blasts in bone marrow or peripheral blood; > 10% blasts with complex cytogenetics; or > 20% immature monocytic cells with blasts. Results: 16 patients with B-ALL (8 female, 8 male). Median age at diagnosis was 47, with the youngest patient being 18 and the oldest 69-years old. All except one patient were classified as high risk at diagnosis. 11 of the 16 patients (68.8%) died during follow-up. Median overall survival was 8.5-months (95% CI: 6.2 – not reached). Median disease-free survival was 8.1 months (95% CI: 5.1 – not reached). Five patients died from infections, four from disease progression, and two while at the bone marrow transplant center. As for treatment, 10 patients underwent induction with HyperCVAD. 5 were Philadelphia chromosome positive and 4 had access to imatinib, but the outcome was negative for all 5 patients. 5 received the modified GRAALL 2003 protocol (lenograstim and daunorubicin from were replaced with filgrastim and doxorubicin, respectively) and 1 patient received the modified CALGB 9111 protocol (daunorubicin was replaced with doxorubicin). 2 received Rituximab during induction (one with HyperCVAD, the other with GRAAL), and were both alive at the end of this study. 1 patient was refractory and 4 relapsed after induction. FLAG-Mito (fludarabine, cytarabine, granulocyte colony-stimulating factor, and mitoxantrone) was used as second line therapy for these patients and outcomes were extremely poor: four died from disease progression and one from infection. None of them achieved complete remission after the diagnosis of relapsed or refractory disease. Discussion: Although the poor outcomes of this study could be due to demographic characteristics, they could also be explained by the lack of access to target therapies: the addition of rituximab to induction chemotherapy is associated with improved outcomes, but not yet provided SUS. Also, the five patients who were refractory/relapsed after first-line induction therapy would have been candidates for other therapies not provided by SUS, such as blinatumomab, inotuzumab ozogamicin, or CAR T-cell therapy. Traditional chemotherapy also results in higher exposure to toxicities, as shown by the high number of deaths caused by infection, likely related to treatment induced immunosuppression. Conclusion: Outcomes for adult B-cell ALL patients in this cohort were poor, with short overall and disease-free survival. Limited access to effective targeted and immunotherapy options, particularly in the relapsed or refractory setting, may have contributed to these unfavorable outcomes and highlights the need to expand access to novel therapies within the Brazilian public health system.
SN  - 2531-1379
SN  - 2531-1387
ER  -