Early Induction Outcomes in Acute Myeloid Leukemia: Impact of Clinical Status, Infectious Complications, Cardiometabolic Comorbidities, and Diagnostic Features in a Cohort Study.

Abstract

Background: Induction chemotherapy outcomes in acute myeloid leukemia (AML) remain suboptimal in many low- and middle-income countries due to delayed diagnosis, limited supportive care resources, and treatment-related complications. Data regarding predictors of induction outcomes in resource-limited settings remain scarce. This study aimed to evaluate day-28 induction outcomes and identify clinical, laboratory, infectious, comorbidity-related, and diagnostic factors associated with unfavorable induction outcomes in adult AML patients. Methods: This observational cohort study included 90 adult patients with newly diagnosed non-acute promyelocytic leukemia (non-APL) AML who received induction chemotherapy between January 2020 and December 2024 at Al-Azhar University Hospitals, Cairo, Egypt. Day-28 induction outcomes were categorized as complete remission (CR), refractory disease (R), or induction-related death (IID). Unfavorable induction outcome was defined as refractory disease or IID. Baseline demographic, clinical, laboratory, infectious, comorbidity, immunophenotypic, and cytogenetic variables were analyzed using univariate and multivariate logistic regression models. Results: Among the 90 patients, 53 (58.9%) achieved CR, 20 (22.2%) had refractory disease, and 17 (18.9%) experienced IID. Poor ECOG performance status (≥2) was significantly associated with unfavorable induction outcomes in both univariate (OR = 4.58, 95% CI: 1.74 - 12.08, P = 0.002) and multivariate analyses (OR = 3.96, 95% CI: 1.39 - 11.27, P = 0.010). Severe thrombocytopenia (<50 ×10³/μL) and higher peripheral blood blast burden were also associated with poorer induction outcomes on univariate analysis. Patients with comorbidities demonstrated lower CR rates compared with patients without comorbidities, although this association did not reach statistical significance. Hypovolemic/hemorrhagic shock and sepsis were the leading causes of IID. Conclusions: Day-28 induction outcomes in AML patients from this resource-limited setting were strongly influenced by baseline functional status and disease burden. Poor ECOG performance status was the strongest independent predictor of unfavorable induction outcome. The findings highlight the importance of early risk stratification, optimized supportive care, and individualized induction strategies to improve AML outcomes in low-resource healthcare environments.