Acute myeloid leukemia outcome in developing countries: a single center experience as an example in patients aged less than 60 years

Background
Acute myeloid leukemia (AML) is a heterogeneous malignancy with a wide variety of clinical presentations, morphological features, and immunophenotypes. Risk stratification at diagnosis is required for prognostic purposes and may also guide treatment decisions. Prognosis in AML is extremely variable, depending on patient-specific factors such as age, performance status, and comorbidities; and disease-specific factors such as white blood cell count, cytogenetics, and molecular aberration, and prior chemotherapy or radiation therapy.


Aim
Analyzing clinicopathological features of AML patients and evaluating outcomes and causes of death in these patients treated in a single tertiary care center from 2021 to 2023 in Upper Egypt.


Methods
We evaluated 93 AML patients from July 1, 2021 to December 31, 2023. Our patients were classified into favorable, intermediate, and adverse risk per the European Leukemia Network 2022 risk stratification. All patients received ‘3 + 7’ induction therapy with modification. The further treatment was according to response to induction therapy, these treatments include consolidation therapy, salvage therapy, and/or allogeneic stem cell transplant.


Results
The median age of our patients was 38 years (range, 18–60). Most patients had monocytic differentiation (63.4%), 55 (59.1%) patients had intermediate risk, followed by favorable risk in 26.9%, and the rest of the patients had adverse risk. Objective response rate of the treated population was 47.3%. At a median follow-up of 13.7 months [95% confidence interval (CI): 11.9–15.4], the median relapse-free survival was 2.4 months (95% CI 1.4–3.4) and the median overall survival was 2.7 months (95% CI 1.7–3.6). The main causes of death in our patients were infection and bleeding, other causes included disseminated intravascular coagulation, cardiogenic shock, and organ failure.


Conclusion
In spite of good Objective response rate, the relapse-free survival and overall survival were poor. These results may be due to different ethnicity and unavailability of targeted therapy.