We conducted a study of 54 adult patients with acute nonlymphoblastic leukemia that was diagnosed over a 5-year period at Central Hospital, Tripoli, Libya. The majority of patients presented with anemia, fever, petechiae, and retinal hemorrhages. Our patients were younger (median age, 34 years) and the disease was more advanced at the time of presentation than that seen in the West. Thirty-seven patients were given induction chemotherapy comprising cytosine arabinoside, daunorubicin, and 6-thioguanine. Fifteen patients (40%) achieved complete remission, with a median survival of 40 weeks. There was partial remission in another 11 patients (30%), and 17 patients died before chemotherapy was begun. Overall long-term results were generally poor. Common causes of death were septicemia and intracranial hemorrhage. There were practical difficulties in carrying out autologous and allogenic bone marrow transplantation, as patients had to be referred abroad. Facilities for treating patients with acute leukemia need to be improved. Acute nonlymphoblastic leukemia (ANLL) is a relatively uncommon disease and presents commonly with anemia, fever, and bleeding. Until about ten years ago, the condition was rapidly fatal; complete remission was achieved in about 20% of the cases and median survival was less than six months.1 Over the last few years, high remission rates of between 60 and 92% have been reported following the judicious use of combination chemotherapy comprising daunorubicin (an anthracycline antibiotic), cytosine arabinoside (a pyrimidine analogue), and 6-thioguanine (a purine analogue).2-6 These regimens are severely myelotoxic and intensive care in the form of blood component therapy and broad-spectrum antibiotics is required during the period of hypoplasia. The overall long-term survival in patients is about 25% and most suffer relapse within two years of remission.7 Relapses are generally fatal as they are refractory to chemotherapy. Allogenic bone marrow transplantation during first remission has been helpful in offering prolonged disease-free survival and possible cure. 8 We discuss our experience with ANLL in adult patients seen between January 1981 and March 1986 at Central Hospital, Tripoli. This is the largest referral hospital in western Libya, which has a population of about two million.
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