Conference Abstracts - 2026 National Summit on Hematologic Cancers
Vol. 6, Issue Supplement 2, 2026 · S1-2
Predictors of Early Mortality After Induction Chemotherapy in Acute Myeloid Leukemia: Experience from a Latin American Cancer Center
Melanie Castro Mollo, MD,Marcos Heredia-Vallejos, MD,Junior Carbajal, BA,Kevin J Paez, MD,Naty Lopez, MD,Jessica Meza, MD,Juan Carlos Haro, MD,Victor Mallma, MD,Lourdes Lopez, MD,Cindy Alcarraz, MD,Jule Vasquez, MD,Shirley Quintana, MD
Submission received: 2026-08-10 / Accepted: 2026-08-25 / Published: 2026-09-28
Abstract
Background
Early mortality, defined as death within 30 days of induction chemotherapy, remains a critical barrier to improved outcomes in acute myeloid leukemia (AML) in Latin America. We aimed to identify pre-treatment patient and disease related factors that predict early death in adults receiving intensive induction therapy at a major cancer center in Peru.
Methods
We conducted a retrospective cohort study of 325 adults (≥18 years) with newly diagnosed AML treated with intensive chemotherapy at the Instituto Nacional de Enfermedades Neoplásicas (INEN), Lima, Peru, from 2014 to 2019. Baseline clinical, laboratory, cytogenetic, and molecular data were collected from medical records. Early mortality was defined as death within 30 days of induction. Associations between baseline variables and early death were assessed using univariable and multivariable logistic and Cox regression models.
Results
Among 325 newly diagnosed AML patients, early mortality occurred in 79 (24.3%). The cohort was a median age of 43 years; patients experiencing early death were older (p=0.03). Comorbidities were more frequent among patients with early mortality (28% vs. 18%, p=0.07). Fifteen patients had ECOG 3–4 at diagnosis; 11 of these died within 30 days, demonstrating a strong association between poor performance status and early mortality (p<0.001). Infection prior to chemotherapy was markedly more common in the early mortality group (58% vs. 24%, p<0.001). Patients experiencing early mortality were more likely to have adverse ELN risk disease (21% vs. 9.5%), while favorable risk was less frequent (9.7% vs. 27%). Albumin levels were significantly lower among patients with early mortality. Complications during induction were frequent, with pneumonia being significantly more common in the early mortality cohort (p<0.001). Bloodstream infections were predominantly caused by Gram-negative organisms, with no significant differences in multidrug-resistant pathogens. In univariable analysis, age ≥45 years was associated with increased 30-day mortality (HR: 2.02; 95% CI: 1.17–3.50; p=0.011). Poor performance status (ECOG 3–4) was the strongest predictor of early death in univariable (HR: 8.91; 95% CI: 3.73–21.27; p<0.001) and multivariable analyses (HR: 8.45; 95% CI: 3.37–21.19; p<0.001). Comorbidities remained independently associated (HR: 2.44; 95% CI: 1.36–4.39; p=0.003), as did adverse cytogenetic risk (HR: 3.17; 95% CI: 1.02–9.84; p=0.045) and active infection prior to chemotherapy (HR: 3.42; 95% CI: 1.96–5.98; p<0.001).
Conclusion
Early mortality remains a substantial challenge in AML in resource-limited settings, even among relatively young patients. Poor performance status, comorbidities, adverse cytogenetics, and infection prior to therapy are strong, independent predictors of early death.