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Real-world challenges in the management of acute myeloid leukemia: a single-center experience from North India

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Abstract

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.

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Data availability

The data that support the findings of this study are available on request from the corresponding author, Dr. Soniya Nityanand.

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Acknowledgements

The study was carried out in Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow. We acknowledge the contribution of clinical hematologist Dr. Rajesh Kashyap for the recruitment of patients. We also acknowledge the significant contribution of hematopathologists, Dr. Ruchi Gupta, Dr. Dinesh Chandra, and Dr. Manish Kumar Singh. We also acknowledge all clinical & lab hematology senior residents, and nursing staff without whom this study was impossible.

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Authors and Affiliations

  1. Department of Hematology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, UP, 226014, India

    Priyanka Chauhan, Anshul Gupta, M. Gopinathan,  Sanjeev, Smriti Khanna, Ruchi Gupta, Khaliqur Rahman, Dinesh Chandra, Manish Kumar Singh & Soniya Nityanand

  2. Department of Medical Oncology, Gujrat Cancer & Research Institute, Ahmedabad, Gujrat, India

    Akanksha Garg

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  1. Priyanka Chauhan
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Correspondence to Soniya Nityanand.

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Ethics approval statement

The study has been approved by Institution Ethics Committee (IEC no 2021–5-EMP-116).

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Written informed consent has been taken from all patients included in the study.

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Chauhan, P., Gupta, A., Gopinathan, M. et al. Real-world challenges in the management of acute myeloid leukemia: a single-center experience from North India. Ann Hematol 101, 1261–1273 (2022). https://doi.org/10.1007/s00277-022-04814-x

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