PMID- 37442650
OWN - NLM
STAT- Publisher
LR  - 20230713
IS  - 2531-1387 (Electronic)
IS  - 2531-1379 (Linking)
DP  - 2023 Jul 7
TI  - Are delays in diagnosis and treatment of acute leukemia in a middle-income 
      country associated with poor outcomes? A retrospective cohort study.
LID - S2531-1379(23)00125-6 [pii]
LID - 10.1016/j.htct.2023.05.010 [doi]
AB  - INTRODUCTION: Acute leukemias (ALs) are aggressive diseases that lead to death 
      without medical attention. We evaluated the association between delays in 
      diagnosis and poor outcomes in AL by evaluating the symptom onset to treatment 
      intervals in adults with newly diagnosed AL and their effect on an early death 
      (ED). METHODS: We assessed adults diagnosed with AL between 2015 and 2020 and 
      evaluated baseline characteristics, the patient interval (PI), diagnostic 
      interval (DI), treatment interval (TI) and the total time interval (TTI) to 
      determine ED-associated factors. MAIN RESULTS: We assessed 102 patients with 
      acute lymphoblastic leukemia (ALL), 57 with acute myeloblastic leukemia (AML) and 
      29 with acute promyelocytic leukemia (APL). Median interval days were PI 14, DI 
      10, TI 4 and TTI 31.5. The TI and TTI intervals were lower in APL than in ALL and 
      AML; TI 1 vs. 4 and 3 (p = 0.001) and TTI 21 vs. 31 and 35 (p = 0.016). The 
      30-day and 60-day EDs were 13.8% and 20.7%, mainly infections. ECOG > 2 
      (OR = 15.0) and PI < 7 days (OR = 4.06) were associated with 30-day ED; AML 
      (OR = 2.69), high-risk (OR = 3.34), albumin < 3.5 g/dl (OR = 5) and platelets < 
      20 x 10(3)/uL (OR = 2.71) with a 60-day ED. CONCLUSION: None of the 
      interval-delays were associated with an ED. Intervals seemed to be longer in 
      patients without an ED, except for the TI, probably because of "the waiting time 
      paradox." Aggressive manifestations of disease may lead to shorter diagnostic 
      intervals, but increased mortality.
CI  - Copyright (c) 2023 Associacao Brasileira de Hematologia, Hemoterapia e Terapia 
      Celular. Published by Elsevier Espana, S.L.U. All rights reserved.
FAU - Lopez-Garcia, Yadith Karina
AU  - Lopez-Garcia YK
AD  - Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, 
      Mexico.
FAU - Valdez-Carrizales, Mayra
AU  - Valdez-Carrizales M
AD  - Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, 
      Mexico.
FAU - Nunez-Zuno, Jorge Adrian
AU  - Nunez-Zuno JA
AD  - Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, 
      Mexico.
FAU - Apodaca-Chavez, Elia
AU  - Apodaca-Chavez E
AD  - Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, 
      Mexico.
FAU - Rangel-Patino, Juan
AU  - Rangel-Patino J
AD  - Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, 
      Mexico.
FAU - Demichelis-Gomez, Roberta
AU  - Demichelis-Gomez R
AD  - Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, 
      Mexico. Electronic address: roberta.demichelisg@incmnsz.mx.
LA  - eng
PT  - Journal Article
DEP - 20230707
PL  - Brazil
TA  - Hematol Transfus Cell Ther
JT  - Hematology, transfusion and cell therapy
JID - 101725732
OTO - NOTNLM
OT  - Adult
OT  - Cancer
OT  - Early death
OT  - Leukemia
OT  - Mexico
COIS- Conflicts of interest No potential conflicts of interest were reported by the 
      authors.
EDAT- 2023/07/14 13:07
MHDA- 2023/07/14 13:07
CRDT- 2023/07/13 21:57
PHST- 2022/05/25 00:00 [received]
PHST- 2023/02/04 00:00 [revised]
PHST- 2023/05/28 00:00 [accepted]
PHST- 2023/07/14 13:07 [medline]
PHST- 2023/07/14 13:07 [pubmed]
PHST- 2023/07/13 21:57 [entrez]
AID - S2531-1379(23)00125-6 [pii]
AID - 10.1016/j.htct.2023.05.010 [doi]
PST - aheadofprint
SO  - Hematol Transfus Cell Ther. 2023 Jul 7:S2531-1379(23)00125-6. doi: 
      10.1016/j.htct.2023.05.010.