Acute Myeloid Leukemia: To Treat or Not to Treat – Experience from a Resource-limited Setting

Abstract

BACKGROUND: Acute myeloid leukemia (AML) is a group of hematologic malignancies characterized by proliferation of blasts of myeloid lineage in the bone marrow and or peripheral blood or tissues. Treatment outcome remains abysmal in our locality. OBJECTIVE: The aim was to determine the impact of treatment on survival in AML patients in a resource-limited setting. MATERIALS AND METHODS: A 5-year retrospective study was conducted in two tertiary healthcare facilities in Nigeria. Data were retrieved from the case files of patients diagnosed with AML from July 2016 to June 2021. RESULTS: A total of 53 patients; males (n = 28, 52.8%), females (n = 25, 47.2%). Majority (n = 49; 92.5%) had anemia (mean hemoglobin 6.8 ± 2.2 g/dL); 41 (77.4%) leukocytosis (median white blood cell 61 × 109/L); 46 (86.8%) thrombocytopenia; (median platelets 39 × 109/L); while 4 (7.5%) had pancytopenia. The most frequent FAB morphological subtypes of AML were M2 (n = 17, 32.1%; [males, n = 7, 41.2%; females, n = 10, 58.8%]) and M1 (n = 11, 20.8%; [males, n = 7, 63.6%; females, n = 4, 36.4%]). Seven (13.2%) were lost to follow-up. Twenty-six (49.1%) did not receive chemotherapy while 27 (50.9%) received chemotherapy; DA 3 + 7 given as daunorubicin 50 mg/m2 days 1–3 and intravenous cytarabine 100 mg days 1–7 was the most common regimen. The overall mortality rate for all patients was 75.5%. The treated arm had a higher mortality rate of 81.5% compared to the untreated arm (69.2%), however, this was not statistically significant (P = 0.3). Median survival for all patients was 1.0 month, with a 3-year survival rate of 5.92%. There was no difference in the median survival of patients who received versus those who did not receive chemotherapy (1.03 months vs. 0.97 months; P = 0.49). CONCLUSION: AML remains an aggressive malignancy with grave outcome in our resource-limited setting despite receiving chemotherapy