Inferior Survival of Chronic Phase Chronic Myeloid Leukemia Patients in Public Health System Compared to Social Security and Private Systems in Perú: A Real-Life Study

Background: The prognosis and survival of Chronic myeloid leukemia (CML) patients have improved in the last decades. Peru is a developing country without a national register of Cancer, where CML patients are seen in three different healthcare systems with some disparities, the objective of this study is to compare the clinical characteristics of patients with CML at diagnosis and survival by healthcare system.

Methods: We performed a real-life observational retrospective study collecting epidemiological and clinical data of newly diagnosed CML patients from three different settings: public health (PH), social security (SS) and private (P). All the patients were treated according to the guidelines and resources of each center and the data was obtained from their respective database.

Results: We obtained data from 785 CML patients older than 14 years who were treated in three different healthcare systems since 2010: 297 patients at public health (PH), 424 at social security (SS) and 64 at private (P), respectively.

At the time of CML diagnosis, fewer patients were diagnosed in chronic phase (PC) at PH system (82.5%) compared to 95.4% and 95.3% at SS and P systems, respectively.

A total of 531 chronic phase (CP) patients had completed data and were evaluated. At Public system we found younger patients (mean age 41.3yo vs 47.9yo and 51yo for PH, SS and P), major M/F ratio (2.21 vs 1.65 and 1.13 for PH, SS and P), lower Hb levels (9.5 vs 10.17 and 11.3 g/dL for PH, SS and P systems), higher WBC (231 vs. 201 and 189 x 10⁹/L for PH, SS and P).

About risk scores, fewer patients had high-risk Sokal score in P system (32.6%) in comparison with SS (54.8%) and PH (59.8%). In contrast, more pts had high-risk ELTS score in PH system (38.6%) compared to SS (23.6%) and P (18.4%).

Because of similarities we pooled the survival data of P and SS system and compared with PH, we found an inferior OS at PH compared to P and SS: 5y OS and 10y OS at PH was 81.5% and 72.1% in contrast to 91% and 81.9% for combined P and SS (Log-rank p 0,02).

Conclusion: The CML patients at public health system had more advanced phases of disease, were younger and had more adverse characteristics at diagnosis, and it correlates with inferior OS. This study could be used to promote national measures of public health to improve the outcome of CP CML patients in our country.

No relevant conflicts of interest to declare.