Access to Therapy for Acute Myeloid Leukemia in the Developing World: Barriers and Solutions
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LEUKEMIA (A AGUAYO, SECTION EDITOR)
Access to Therapy for Acute Myeloid Leukemia in the Developing World: Barriers and Solutions Luis Antonio Meillon-Garcia 1 & Roberta Demichelis-Gómez 2 Accepted: 4 September 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Acute myeloid leukemia (AML) is a costly disease, and its impact is greater in developing countries (DC). We will review the current concept of what are DC, compare the differences in the epidemiology and economic burden of this disease between developed and DC, and finally, analyze the barriers and possible solutions that DC should implement to achieve better results. Recent Findings DC is a frequently misunderstood name. The way we use to measure human development is changing, and multidimension metrics better define what are DC. With this in mind, we show the differences in the AML epidemiology and the impact of economic burden in DC. We analyze the barriers to access therapy from a clinician point of view, to show that most DC shared similar challenges but with a diverse healthcare structure. Finally, we provide several possible solutions for a more integrated and timely treatment that allows better results not only in terms of survival but with a better quality of life. Summary The economic burden of AML treatment in DC is high, and the results are poor. It is crucial to face this challenge and propose new treatment approaches to achieve better results. Keywords Leukemia . Acute leukemia . Acute myeloid leukemia (AML) . Developing countries . AML treatment . Healthcare
Introduction to AML Acute myeloid leukemia (AML) has the highest incidence of adult acute leukemias in developed countries, with an estimated incidence of 4.3 new cases per 100,000 in the United States (US) in 2018 [1]. Acute myeloid leukemia (AML) is a hematologic malignancy characterized by clonal, abnormally differentiated cells of the hematopoietic system accumulating in the bone marrow, blood, and possibly other organs [2•]. Without treatment, survival is measured in days to weeks [2•]. Fit people with AML are usually offered induction chemotherapy, which This article is part of the Topical Collection on Leukemia * Luis Antonio Meillon-Garcia [email protected] 1
The ABC Medical Center, Cancer Center, Av. Observatorio 325. Cons 208, Ciudad De Mexico 01120, Mexico
2
Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Subirán, SSA, Ciudad De Mexico, Mexico
results in the achievement of complete remission (CR) in most cases. Still, despite post-remission chemotherapy and/or allogeneic hematopoietic cell transplantation (HCT), relapses are common and only a minority of the affected individuals will be long-term survivors [2•]. The 5-year overall survival (OS) rate for all AML patients in the US has improved modestly over several decades from 6.4% in 1975–1977 to 28.1% for patients diagnosed in 2008–14 [3]. Even in the selected patient population receiving intensive therapy, 5-year OS rate ranges between 25 and 40% and decl
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