BACKGROUND: The outcome of acute myeloid leukemia (AML) in low-middle-income countries (LMIC) is dismal due to delayed clinical presentation and infection-related complications. We aimed to analyze the outcome of patients with AML and the factors associated with its prognosis. METHODS: A retrospective observational study was conducted at a tertiary care university hospital in North India from January 2015 to December 2019. RESULTS: A total of 137 AML patients (median age 32 year (3-66 years) received intensive chemotherapy during study period. The median delay from diagnosis to treatment was 45 days (6-177 days). Among the 352 febrile neutropenia (FN) episodes analyzed, 175 (49.7%) were culture positive; Gram-negative multi-drug resistant organism (MDRO) sepsis during induction being 57.4% with 34.5% infections due to carbapenem-resistant Enterobacteriaceae (CRE) leading to a mortality rate of 14.6%. The median EFS and OS were 12.0 ± 1.57 (95% CI 8.91-15.08) and 15.0 ± 2.44 (95% CI 10.21-19.78) months respectively. Multivariable analysis revealed significant difference in median OS between favorable vs high risk AML groups (20.0 (95% CI: 12.50-27.49) vs 9.0 (95% CI: 2.99-15.01) months; p = 0.002); time from diagnosis to treatment (< 30 days vs ≥ 30 days; not reached vs 9.0 (95% CI: 6.81-11.18) months; p = 0.001), performance status (1 vs 2 vs 3; not reached vs 12.0 (95% CI: 10.32-13.67) vs 4.0 (95% CI:2.77-5.22); p = 0.001), and attainment of complete remission vs induction failure (not reached vs 6.0 (95% CI: 3.78-8.21); p = 0.002). CONCLUSION: Patient-related factors like delayed treatment initiation and high incidence of MDRO-associated sepsis are critical determinants of AML outcome in LMIC.
BACKGROUND: The outcome of acute myeloid leukemia (AML) in low-middle-income countries (LMIC) is dismal due to delayed clinical presentation and infection-related complications. We aimed to analyze the outcome of patients with AML and the factors associated with its prognosis. METHODS: A retrospective observational study was conducted at a tertiary care university hospital in North India from January 2015 to December 2019. RESULTS: A total of 137 AML patients (median age 32 year (3-66 years) received intensive chemotherapy during study period. The median delay from diagnosis to treatment was 45 days (6-177 days). Among the 352 febrile neutropenia (FN) episodes analyzed, 175 (49.7%) were culture positive; Gram-negative multi-drug resistant organism (MDRO) sepsis during induction being 57.4% with 34.5% infections due to carbapenem-resistant Enterobacteriaceae (CRE) leading to a mortality rate of 14.6%. The median EFS and OS were 12.0 ± 1.57 (95% CI 8.91-15.08) and 15.0 ± 2.44 (95% CI 10.21-19.78) months respectively. Multivariable analysis revealed significant difference in median OS between favorable vs high risk AML groups (20.0 (95% CI: 12.50-27.49) vs 9.0 (95% CI: 2.99-15.01) months; p = 0.002); time from diagnosis to treatment (< 30 days vs ≥ 30 days; not reached vs 9.0 (95% CI: 6.81-11.18) months; p = 0.001), performance status (1 vs 2 vs 3; not reached vs 12.0 (95% CI: 10.32-13.67) vs 4.0 (95% CI:2.77-5.22); p = 0.001), and attainment of complete remission vs induction failure (not reached vs 6.0 (95% CI: 3.78-8.21); p = 0.002). CONCLUSION: Patient-related factors like delayed treatment initiation and high incidence of MDRO-associated sepsis are critical determinants of AML outcome in LMIC.
Authors: Mariana Tereza de Lira Benicio; Ana Flávia Tibúrcio Ribeiro; Andre D Américo; Felipe M Furtado; Ana B Glória; Aleide S Lima; Silvana M Santos; Sandra G Xavier; Antonio R Lucena-Araujo; Evandro M Fagundes; Eduardo M Rego Journal: Leuk Res Date: 2017-07-24 Impact factor: 3.156
Authors: Hugo F Fernandez; Zhuoxin Sun; Xiaopan Yao; Mark R Litzow; Selina M Luger; Elisabeth M Paietta; Janis Racevskis; Gordon W Dewald; Rhett P Ketterling; John M Bennett; Jacob M Rowe; Hillard M Lazarus; Martin S Tallman Journal: N Engl J Med Date: 2009-09-24 Impact factor: 91.245
Authors: Ewa Lech-Maranda; Marek Seweryn; Sebastian Giebel; Jerzy Holowiecki; Beata Piatkowska-Jakubas; Joanna Wegrzyn; Aleksander Skotnicki; Marek Kielbinski; Kazimierz Kuliczkowski; Monika Paluszewska; Wieslaw Wiktor Jedrzejczak; Magdalena Dutka; Andrzej Hellmann; Marcin Flont; Barbara Zdziarska; Grazyna Palynyczko; Lech Konopka; Tomasz Szpila; Krzysztof Gawronski; Kazimierz Sulek; Jaroslaw Sokolowski; Janusz Kloczko; Krzysztof Warzocha; Tadeusz Robak Journal: Int J Infect Dis Date: 2009-07-05 Impact factor: 3.623
Authors: Brenda E S Gibson; David K H Webb; Andrew J Howman; Siebold S N De Graaf; Christine J Harrison; Keith Wheatley Journal: Br J Haematol Date: 2011-09-09 Impact factor: 6.998