May 25, 2024

Addressing Resource Shortages and Technological Lag in Acute Myeloid Leukemia Treatment in Latin America

Acute myeloid leukemia (AML), a cancer that originates in the bone marrow, is the most common type of acute leukemia. It requires immediate treatment due to its rapid progression. While significant advancements have been made in treating AML, these resources are not easily accessible in underdeveloped countries, including those in Latin America. As a result, scientists in Latin America are striving to gain a comprehensive understanding of AML on the continent, with a primary focus on available therapies and diagnostic methods tailored to this population.

The Hematology Science Journal recently published a study coordinated by the D’Or Institute for Research and Education (IDOR) in partnership with the University of São Paulo (USP), Universidad Autónoma de Nuevo León, and the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Collaborators from 15 Latin American countries also contributed to the study. Such collaborations provide opportunities for scientific advancements, as different countries possess varying expertise in certain techniques or treatments. This exchange of knowledge generates human resources for Latin America, according to Dr. Eduardo Rego, the research coordinator and a hematologist researcher at IDOR and professor at USP.

In AML, the bone marrow irregularly produces and releases immature cells called blasts into the bloodstream, causing harm to other organs. AML typically involves the proliferation of myeloid cells, primarily leukocytes, and in rare cases, mast cells or macrophages.

To diagnose AML, specialized tools like flow cytometry (used for cell counting and classification), cytogenetic evaluations (including reading karyotypes and identifying chromosomal abnormalities), and molecular tests (for mutation analysis) are employed. However, access to these resources is limited in Latin America, where most laboratories still work with four-color flow cytometry, reducing the accuracy of examination results in identifying residual disease in patient samples.

Additionally, while comprehensive genetic testing is standard in developed countries, Latin American countries face challenges in standardizing karyotype tests for studying chromosomal abnormalities. The study highlights that between 2010 and 2018, successful karyotype analysis was performed in only 46% to 61% of AML cases in Latin America, indicating the need for improved training of medical teams. Accessibility limitations and high costs further hinder the availability of these tests.

The availability of AML therapies also varies across high- and low-income countries, even within Latin America. For example, intensive induction chemotherapy, a primary treatment for AML, has a 3% to 6% early mortality rate in recent clinical trials. However, in low- and middle-income countries like Brazil, this rate increases to 41% among older adults. The authors suggest urgent treatment measures for patients with highly elevated white blood cell counts, as they have the highest mortality rate during induction treatment. They also emphasize the importance of considering the patient’s comorbidities, as many AML patients have underlying health conditions that worsen the disease.

Treatment delays due to waiting for genomic results and shortages of chemotherapy drugs—resulting from mismanagement of government resources—are ongoing obstacles faced by Latin American countries.

The study also highlights the heterogeneity among Latin American countries when it comes to AML aspects. In Brazil, for example, there is a concentration of resources in the Southeast region, which affects the availability of AML therapies.

Apart from chemotherapy, bone marrow transplantation—now called hematopoietic stem cell transplantation—is a crucial treatment for severe AML cases. This technique aggressively treats the disease using marrow-toxic drugs, with recovery occurring from young cells of the patient or donor cells. In Latin America, haploidentical donation has greatly facilitated allogeneic transplants. This method only requires 50% compatibility, usually achieved by a first-degree relative of the patient.

Due to a lack of unrelated donor registries, most Latin American countries face challenges in finding compatible donors. However, Brazil stands as an exception with the Brazilian Registry of Volunteer Bone Marrow Donors (REDOME). In the absence of suitable donors, the study suggests considering autologous transplantation—as it reduces adverse effects such as the need for blood transfusion and hospitalizations—making it an effective and economical option in Latin America.

Previous research on autologous transplants following chemotherapy treatment observed an overall survival rate of 74% to 79% at two years, with a disease-free survival rate of 61%.

Considering the specific challenges associated with AML diagnosis and treatment in Latin America, the authors emphasize the importance of scientific collaborations led by Latin American researchers to adapt therapies to the region’s needs. They also stress the need for investments in clinical education and accessible therapies in Latin America and other low- and middle-income countries that face similar challenges and disparities in AML treatment.

1. Source: Coherent Market Insights, Public sources, Desk research
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