]Socioeconomic Factors May Select Adults Younger Than 60 Years of Age with “De Novo” Acute Myeloid Leukemia To Receive Intensive Treatment outside a Clinical Trial in Developing Countries. Experience of a Brazilian University Center.

Socioeconomic status (SES) is associated with treatment outcomes of ALL childhood. Whether this factor is associated with outcomes in adults AML in a developing country is not known. We have studied the impact of the human development index (HDI) of the United Nations as a SES factor for treatment outcomes of adults with “de novo” AML. Among 124 consecutive patients retrospectively analyzed, 46 (37 %) died during induction, 66 reached complete remission (53%) and 46 (37%) received high dose Ara-C (Hidac) consolidation. Five years-overall survival (OS) and leukemia free survival (LFS) were 17%±3% and 26%±6% respectively for all patients and 36%±7% and 30%±7% respectively for those receiving Hidac. In multivariate analysis, the HDI lower than 0.660 was associated with lower probability to receive Hidac (p=0.001), a trend for higher mortality in remission induction (p=0.062) and a decreased LFS (p<0.0001), however it was not associated with outcomes for patients receiving Hidac. In conclusion, survival for patients who received Hidac consolidation is similar to those reported in developed countries, but results of overall outcomes are inferior, probably due to the influence of socio-economic factors before Hidac consolidation. Poor SES may be a factor associated with patient selection for intensive treatment and survival.