Incidence, etiology, and predictors of early mortality after induction chemotherapy for aml in a middle-income country

Introduction: Early mortality (EM) in acute myeloid leukemia (AML) represents a significant challenge in middle-income countries. This study determined the 30-day and 60-day EM rates and identified independent prognostic factors at a Peruvian national reference center. Methods: Retrospective cohort of 139 adults treated with 7 + 3 induction chemotherapy at the Hospital Nacional Edgardo Rebagliati Martins (2020–2024). Cox proportional hazards models were used to estimate adjusted hazard ratios (aHR). Results: The 30-day and 60-day EM rates were 17.3% (24 deaths) and 24.5% (34 deaths), respectively, 79.4% of deaths were of infectious etiology. ICU admission was the strongest predictor of 30-day mortality (aHR 12.88; 95% CI 4.87–34.08), with a time-dependent effect attenuating beyond day 21. The post-induction complete remission (CR) rate was 54.0%; patients achieving CR had markedly superior survival (log-rank p < 0.001). Age ≥ 60 years was not an independent predictor of early death. Conclusions: Early mortality substantially exceeds European benchmarks, driven primarily by infectious complications and clinical severity at presentation. ICU admission is a critical prognostic indicator; chronological age should not preclude intensive induction therapy.