# Survival predictors in Vietnamese elderly AML patients treated with decitabine: Real-world evidence from a low- and middle-income country

## TL;DR

This study identifies factors that predict survival in elderly Vietnamese patients with AML treated with decitabine, offering insights for low- and middle-income countries.

## Contribution

The study identifies bone marrow cell count as a novel prognostic marker and provides real-world evidence from a low- and middle-income country.

## Key findings

- Five baseline variables independently predicted 1-year overall survival in elderly AML patients.
- CD64 positivity and urban residence were associated with better survival outcomes.
- Bone marrow cell count was identified as a novel prognostic marker for mortality.

## Abstract

•Real-world study of elderly AML patients treated with decitabine in Vietnam.•Five baseline variables independently predicted 1-year overall survival.•Urban residence was associated with better survival than rural residence.•CD64 positivity was independently linked to lower 1-year mortality.•Bone marrow cell count identified as a novel prognostic marker.

Real-world study of elderly AML patients treated with decitabine in Vietnam.

Five baseline variables independently predicted 1-year overall survival.

Urban residence was associated with better survival than rural residence.

CD64 positivity was independently linked to lower 1-year mortality.

Bone marrow cell count identified as a novel prognostic marker.

Hypomethylating agents such as decitabine represent a key treatment option for elderly acute myeloid leukemia (AML) patients who are unfit for intensive chemotherapy. However, real-world evidence from low- and middle-income countries (LMICs), including Vietnam, remains scarce. This study aimed to identify baseline clinical and laboratory predictors of 1-year overall survival (OS) in elderly Vietnamese AML patients treated with decitabine.

This prospective, single-center, observational study was conducted at the National Institute of Hematology and Blood Transfusion, Vietnam, from April 2023 to June 2025. Seventy newly diagnosed AML patients aged ≥ 60 years received decitabine. The primary outcome was 1-year OS. Baseline demographic, clinical, hematologic, and immunophenotypic variables were analyzed using univariate and multivariate Cox regression. Treatment response was descriptively evaluated in patients completing ≥4 cycles.

The 1-year OS rate was 38.6 %, with a median survival of 276.0 days. Elevated bone marrow cell count (HR: 1.003, p = 0.002), fibrinogen (HR: 1.22, p = 0.044), and urea (HR: 1.23, p = 0.001) were independently associated with increased mortality. CD64 positivity (HR: 0.29, p = 0.029) and urban residence (HR: 0.43, p = 0.014) were protective. Among 39 patients completing ≥4 cycles, 48.7 % achieved a complete response. No significant survival difference was observed between responders and non-responders.

This first prospective real-world study in Vietnam identified accessible predictors of survival in elderly AML patients receiving decitabine. The findings may aid early risk stratification using simple baseline parameters in LMIC settings, where access to molecular diagnostics may be limited, and warrant multicenter validation.