Acute Myeloid Leukemia at Muhimbili National Hospital: clinical features, laboratory characteristics and survival outcome

Abstract

ABSTRACT Background: Acute myeloid leukemia is a blood cancer characterized by clonal expansion of immature blast cells in the peripheral blood and bone marrow, resulting in ineffective erythropoiesis and bone marrow failure. Chemotherapy is the mainstay of treatment, with bone marrow transplant reserved for patients with an intermediate risk or a high-risk disease. Nevertheless, the majority of AML patients who receive intensive chemotherapy and attain complete remission eventually relapse. Allogeneic stem cell transplant remains an essential treatment option in patients with good performance status. In the absence of timely treatment, AML has a rapid progression rate. Chemotherapy treatment for AML is available in Tanzania, but not always accessible to all patients. Little is known about the survival outcomes of patients with AML in Tanzania. Aim of the study: To determine the clinical features, laboratory characteristics, and survival outcomes of patients with Acute myeloid leukemia treated with different regimens in Tanzania. Materials and methods: This was a retrospective cohort analysis that included all patients with a confirmed diagnosis of AML by bone marrow aspiration from March 2018 to December 2023. Data was acquired from patient files and the electronic hospital record system. SPSS version 21 was used for data analysis. Descriptive statistics like percentage and mean were employed to describe the patients' demographic, clinical, and laboratory characteristics. The survival outcome was determined via the Kaplan-Meier method. Cox proportional hazards models were used to analyze survival results for patients with acute myeloid leukemia, identifying predictors of survival and estimating the correlation between each variable and survival outcomes. A p value of <0.05 was considered significant. Results: The prevalence of AML among all acute leukemia cases at MNH was 68% (n =112). Majority of the patients were females (60.7%), uninsured and had de novo AML. The mean age was 47.2 years (SD = 18.5). Most of the patients presented with symptoms of anemia (98.2%) and fever (79.5%). The median survival time was 81 days with a one-year overall survival of 15.2%. There was increased hazard of mortality for patients who resided outside of Dar es Salaam (74% (aHR: 1.74, 95% CI: 1.15-2.64, p = 0.008) and those whose management constituted supportive treatment alone (aHR: 0.61, 95% CI: 0.40-0.93, p = 0.022). Conclusions: Majority of the patients diagnosed with AML received palliative care and not standard of care. The survival outcome of AML in Tanzania is low. Limitations: Due to the limited number of patients on LD cytarabine with venetoclax, we were unable to compare survival outcomes of patients on LD cytarabine with venetoclax and those on LD cytarabine alone Recommendations: Patients should receive intensive chemotherapy which is deemed standard of care. We also consider the need for future prospective studies to be conducted on patients with AML receiving different treatment regimens, strong emphasis should be placed on the need for risk stratifying patients with AML inclusive of counselling patients for the need of molecular studies and the need for recording performance status (ECOG) in patients’ files