Background: Real-world long-term outcomes for patients with AML in Latin America are not well described. In this analysis we present characteristics, outcomes, and causes of death (COD) of 1390 adults with AML from Chile.

Methods: This is a real-world, multicenter study of adult patients diagnosed with AML, who presented to 26 public institutions in Chile between 2012 and 2024. Data from 1390 patients were analyzed and the COD for 953 deceased patients with AML was determined based on electronic medical record review and death certificates. We collected demographics, cytogenetic results, and vital status. Using cytogenetic data only, we classified patients based on the European LeukemiaNet 2022 (ELN22) risk classification.

Results: Among the 1390 patients, 721 (52%) were male. The median age at diagnosis was 52 years (Q1-Q3: 37-61 years). Thirteen percent had complex karyotype. The three most common cytogenetic abnormalities were trisomy 8 in 126 patients (9.1%), inversion 16 in 70 patients (5%) and monosomy 7 in 60 patients (4.3%). Seven percent had no cytogenetic data available.

In patients aged ≤50 years, the most common abnormalities were trisomy 8 (n=59, 9.8%), inversion 16 (inv16) (n=46, 7.7%), and chromosome 3 abnormalities (n=20, 3.3%). For this group, ELN22 classified 87 patients (15%) as favorable, 441 (74%) as intermediate, and 70 (12%) as adverse. For those aged >50 years, the most common abnormalities were trisomy 8 (n=67, 9.6%), monosomy 7 (n=47, 6.7%), and deletion 5q (n=44, 6.3%). For this group, the ELN classification was favorable for 54 patients (7.8%), intermediate for 513 (74%), and adverse for 129 (19%).

At the time of analysis, 953 patients (69%) were deceased, and the median age of death was 54 years (Q1-Q3: 40–63). The median overall survival (mOS) was 0.9 years. The median OS for the ELN favorable group (n=141, 10%) was 1.6 years (Q1-Q3: 0.4–5.4); for the intermediate group (n=954, 69%), it was 0.9 years (Q1-Q3: 0.2–3.5); and for the adverse group (n=199, 14%), it was 0.3 years (Q1-Q3: 0.1–0.9).

The 30-day mortality rate was 19%, and the 60-day mortality rate was 26%. For patients with mortality at 30 days, the most common cause of death was respiratory failure (27%), followed by pancytopenia (19%). For the entire cohort, the most common causes of death were sepsis (n=210, 22%), respiratory failure (n=183, 19%), AML relapse (n=154, 16%), bleeding (n=87, 9.1%), and multiorgan failure (n=83, 8.7%).

Conclusions: Patients with AML in Chile have an overall survival of less than one year, with one fourth dying within the first sixty days. The ELN appropriately classifies long-term outcomes in this cohort. Myelodysplasia-related cytogenetic changes are prevalent across all age groups. Access to genomic testing may better stratify patients who might not benefit from intensive treatment. Strategies to reduce induction-related deaths from infection would improve outcomes

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2025
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