# A Multicenter Survival Analysis of Adults Type B‐Acute Lymphoblastic Leukemia in Ecuador. A Retrospective Study of the Real World

## TL;DR

This study analyzes survival and treatment outcomes for adult B-cell acute lymphoblastic leukemia patients in Ecuador, finding lower survival rates compared to international standards.

## Contribution

The study provides real-world data on B-ALL outcomes in Ecuador, highlighting unique challenges like high treatment-related mortality and limited access to transplants.

## Key findings

- Median overall survival for Ecuadorian B-ALL patients was 11 months, with a 5-year survival rate of 22.4%.
- Patients under 30 had better complete remission rates and longer survival compared to older patients.
- Treatment-related mortality was 31.5%, with pediatric-inspired protocols showing higher mortality than other regimens.

## Abstract

To describe clinical characteristics, treatment outcomes, and overall survival (OS) of Ecuadorian adults with B‐cell acute lymphoblastic leukemia (B‐ALL).

A retrospective multicenter cohort study was conducted in patients > 15 years diagnosed with B‐ALL between 2015 and 2022 across eight tertiary centers in Ecuador. Medical records of 734 acute lymphoblastic leukemia cases classified by the 2016 WHO criteria were reviewed; 653 B‐ALL patients were included. Multiple frontline chemotherapy regimens were used, and Philadelphia‐positive (Ph+) cases were included.

Among 653 patients, 50.4% were male, with a median age of 31 years (interquartile range, 20–47). Most (93%) received chemotherapy, achieving a complete remission (CR) rate of 53.3% (311/583) and minimal residual disease (MRD) negativity in 49.1% (211/430). Relapse occurred in 62.4% (194/310), and 16 of 164 underwent allogeneic hematopoietic stem cell transplantation (HSCT). Treatment‐related mortality was 31.5%, higher in pediatric‐inspired protocols (34.4% vs. 21.3%, p < 0.001). Patients < 30 years showed better CR (58.3%, p = 0.026) and longer survival (median OS 15 vs. 8 months, p < 0.001). Median OS for the cohort was 11 months, with a 5‐year OS of 22.4%. High‐risk patients had inferior OS (11 vs. 14 months, p = 0.036), while no difference was observed between Ph + and Ph– (12 vs. 11 months, p = 0.319).

Adult Ecuadorian patients with B‐ALL show lower survival than international cohorts, mainly due to high treatment‐related mortality and limited transplantation access. Age was independently associated with response and OS.

Analysis of adults type b‐acute lymphoblastic leukemia in ecuador. This demonstrates inferior response and survival outcomes for b‐all in Ecuador and can serve as a reference to Latin America countries due to geographic, racial and socioeconomic similarities.