Health inequities in survival of patients with acute lymphoblastic leukemia in Peru: A single tertiary institution experience.
Authors: Espinoza-Morales Evelyn Pamela , Espino-Ortiz Johan , Sandival Gustavo , Haro-Varas Juan Carlos , Arnao-Labajos Veronica Yvon , Vidaurre Tatiana , Dueñas Daniela , Cervantes Elizabeth , Valcarcel Bryan , Samanez Cesar Augusto , Flores Claudio J. , Enriquez-Vera Daniel Jair 
Published: June 2022

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Background: Acute Lymphoblastic Leukemia (ALL) in Latino countries is characterized by high incidence and worst outcomes compare to other ethnicities. However, the actual epidemiological characterization of ALL in South America remains unknown. The lack of registries, uniform treatment and prospective protocols have been pointed out for these disparities. Also, biological, and social aspects of this disease play an important role that has not been well examined. We aimed to evaluate the survival of patients with acute lymphoblastic leukemia according to demographic characteristics with emphasis in the place of residence. Methods: We performed an analytical retrospective cohort study with subjects diagnosed and treated for ALL during the period 2016-2018 at the Peruvian national cancer center (INEN, Instituto Nacional de Enfermedades Neoplasicas). INEN is currently the main center dedicated to diagnosing and treat acute leukemias for patients without social neither private insurance. Also, INEN is located at the capital city (Lima-Peru). The calculated sample size was 378 patients. Patient data were obtained from the epidemiological registry and corroborated with the national registry of mortality (RENIEC, Registro Nacional de Identificacion y Estado Civil Overall survival probabilities according to demographic characteristics were estimated using the Kaplan-Meier curve; in addition, the Log-rank test and Cox regression were used. Results: A sample of 378 patients were included during the study period (N = 588), of which 212 (56.8%) were male, 42% were between 0-10 years, 24% in 46-65 years. Regarding the characteristics at diagnosis, 80% were Ph(-) BCP-ALL and 69% corresponded to high-risk groups. At 42 months of follow-up, the median survival of the patients was 29 months (95% CI: 23.3-34.6), and the overall survival at three years was 44.8%. Overall survival in males (48.8%) was higher than in females (39.5%). According to the range of age, the highest survival was in the group of 0-10 years (70%), followed by 11-20 years (36.8%) and the lowest survival was in 46- 65 years (12.5%). Furthermore, overall survival in Lima (51.5%) was higher than in the country-side (39.7%). There was a statistically significant association (p < 0.05) between survival and sex (p = 0.042), age range (p = 0.000) and place of residence (p = 0.005); according to the Log-rank test. Conclusions: We report a lower survival among all age groups in ALL compared to international working groups. Living in a country-side region represents a significant factor for dismal survival in our cohort. Specialized health care access to diagnosis and treatment should be warranted for patients with geographical limitations and programs to ensure it must be implemented.