Characteristics and Survival of 927 Moroccan Adults with Acute Myeloid Leukemia: Monocentric Experience

Abstract

Acute myeloïd leukemia (AML) is the most frequent form of acute leukemia among adults and the most aggressive type of leukemia, which is associated with the lowest survival rate. Patients with AML are treated with intensive chemotherapy and many factors could influence the survival of these patients, such as age, cytogenetic abnormalities; white blood cell (WBC) counts. The aim of this work was to study the epidemiological and response profiles of AML adults patients in Morocco.Patients and Methods: A prospective, descriptive study conducted in the Hematology and Pediatric Oncology department, 20 August Hospital Casablanca, and concerned adult patients diagnosed with AML through a period of seven years (January 2011 to December 2017). Statistical analysis was performed using SPSS version 20. The overall survival and disease-free survival were evaluated by using the Kaplan–Meier method. Results: A total of 927 patients diagnosed with AML during the 7 year period. 466 (50.3%) were males and 461 (49.7%) were females. The median age of patients was 46years.The most represented age group was between 18 and 60 years old with a percentage of 83.2%.The FAB subtype M2 occurred most frequently (27%) followed by M1 (24.8%). The cytogenetic study showed that the majority of patients had a normal karyotype. The t (8; 21) was the most detected balanced translocation in our series and the intermediate cytogenetic group was the most represented group (65.4%). A total of 461 patients (53.54%) were treated according to the protocol AML11. The Disease-free survival (DFS) was significantly better for favorable cytogenetic group as compared to other cytogenetic groups (median survival of 41.58 months for the favorable group versus 29.07 months for the adverse group; p-value = 0.02).Conclusion: The age of AML patients was younger compared to other populations. The majority of patients had a normal karyotype and the commonest balanced translocation was the t (8; 21). Survival was higher in patients with good prognosis.

Genetic Profiles and Risk Stratification in Adult De Novo Acute Myeloid Leukaemia in Relation to Age, Gender, and Ethnicity: A Study from Malaysia

“…Normal karyotypes were reported with varying frequencies between different countries ranging between 25% in a study by Lazarevic et al (2014) in Sweden and 70% in another study in Malaysia that encompasses the paediatric AML. Most studies were consistent with our findings (49%), including studies in other Asian countries that only included adult AML [ 13 , 14 , 18 ]. The higher frequencies of normal karyotype in some of these studies could be due to an admixture of undiscovered chromosomal abnormalities and cryptic aberrations beyond the detectable resolution of conventional cytogenetic cells [ 30 , 31 , 32 , 33 , 34 , 35 ].…”

“…Cytogenetic aberrations were detected in 51% of the cases, commensurable to other cohorts from various geographical locations (range 42–75% abnormalities) [ 13 , 14 , 18 , 27 , 28 , 30 , 42 , 43 ]. Balanced translocations in this cohort were comparable with other studies in other geographical regions.…”

“…AML is a heterogeneous disorder present with a plethora of clinicopathological features, including cytogenetic and molecular genetic findings [ 23 , 24 , 25 ]. Although studies have revealed geographical diversity in cytogenetic aberrations in haematological malignancies, no comprehensive studies encompass the multi-ethnic population in Southeast Asia [ 12 , 13 , 14 , 16 , 18 , 26 , 27 ]. To the best of our knowledge, this is the largest cohort in this region that reports findings from three major ethnic groups in Malaysia, Malay, Chinese and Indians [ 15 , 26 ].…”

“…Reports from some of the Asian countries disclosed the age of presentation of AML was 48 years (median) in Singapore [ 26 ], 51 years (mean) in Japan [ 16 ] and 38 years (median) in India [ 18 ] and 37.5 years (median) in Pakistan [ 17 ]. The age at presentation varied in studies from Europe, America, England, Arab and Africa, ranging between 45 to 71 years [ 3 , 11 , 13 , 14 , 28 , 29 ]. The age variations are not ascertained whether it is related to geographical regions or ethnicity or due to the patient referral system in the study region [ 26 ].…”

“…In recent years, the advent of molecular genetics markers, including mutations, has heralded new prognostication in AML, and today, genetic abnormalities are paramount features of AML based on the 2016 World Health Organisation classification [ 11 ]. However, relatively few data on genetics and age association have been published in the South Asia region, though studies in other geographical regions revealed that the increase in adverse cytogenetic and genetics aberrations occur continuously over a life span [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 ]. Genetic abnormalities that are essential outcome predictors, and frequently tested in AML, include FMS-like tyrosine kinase-3 gene-internal tandem (FL3-ITD) duplication and nucleophosmin-1 (NPM1) mutations recommended in clinical practice guidelines.…”