Predictors of Morbidity and Mortality During the Induction Phase with Anthracycline plus Cytarabine-Based Chemotherapy in Newly Diagnosed Acute Myelogenous Leukemia: A Retrospective Cohort Study

Author : Ida Corazon Anaya, MD, FPCP, James Abraham D. Malala, MD, FPCP, FPCHTM, Mary Anne Lorraine Kua, MD

Abstract : Rationale and Objectives: This retrospective cohort study identifies clinical and laboratory predictors of 28 day morbidity and mortality during the induction phase of cytarabine plus anthracycline based (“7+3”) chemotherapy in newly diagnosed Acute Myelogenous Leukemia (AML) patients to improve risk stratification. Research Design and Methodology: This study included 111 adult patients with newly diagnosed AML who received standard “7+3” induction chemotherapy between 2015 and 2025 at two tertiary hospitals in the Philippines. Univariate and multivariate Cox proportional hazards regression models were performed to identify independent predictors of 28-day induction-phase morbidity and mortality. Results: Twenty-six patients (23%) experienced induction-phase morbidity or mortality. On univariate analysis, poor functional status (ECOG 3–4, p=0.011), severe thrombocytopenia (platelet count <50,000/μL, p=0.019), renal impairment (creatinine >1.3 mg/dL, p=0.029), and higher serum lactate dehydrogenase (continuous LDH p=0.008) were associated with adverse outcomes. Chronological age was not predictive, while diabetes mellitus demonstrated a borderline association (p=0.062). In the multivariate model, only baseline creatinine >1.3 mg/dL (adjusted Hazard Ratio (aHR)=3.61; 95% Confidence Interval (CI): 1.30 to 9.97; p=0.013) and continuous LDH (aHR = 1.0008 per unit increase; 95% CI: 1.0003 to 1.0014; p=0.004) remained independent predictors. Discussion and Conclusion: Survival during induction-phase is more strongly influenced by baseline renal function and leukemic burden than by chronological age. Pre-induction renal insufficiency and elevated LDH levels are powerful predictors that enable early identification of high-risk patients and guide proactive supportive care during induction chemotherapy.

Keywords : Acute Myeloid Leukemia, 7+3 Chemotherapy, Renal Function, LDH, Mortality, Risk Stratification

Conference Name : International Conference on Hematologic Malignancies and Cancer Research (ICHMR - 26)

Conference Place : Edinburgh, UK

Conference Date : 6th Oct 2026