Mortality Predicted by different Hematological Malignancy types, Bacteremia, and Lack of Chemotherapy at Kinshasa University Clinics

Abstract

Objective To identify environmental, pollutant metals, epidemiological, clinical, therapeutic, and able to predict case fatality among patients with anemia and hematological malignancy (HM). Methods This was a retrospective cohort study in black patient’s ≥ 20 years managed for recurrent fever, infections, anemia, and bacteremia between 2009 and 2015 at Kinshasa University Clinics, DRC. The outcomes such as incident HM and case fatality were assessed using univariate means, standard errors, relative risk (RR) and multivariate proportional Hazard ratio (HR) by Cox regression analysis, while Log-Rank test was performed for comparisons by Kaplan Meier curves (means, 95% CI, and median survival). Results Out of 105 incident HM patients (Male: Female ratio = 1), 57.1% (n= 60) experienced case fatality, There was no association between gender, residence, ethnicity, fever and mortality. There was a significant univariate association between age ≥ 55 years, serum chromium, serum cadmium, serum iodine, serum mercury, rainy season, hemolytic anemia, HM, bone pain, elevated Erythrocyte sedimentation, splenomegaly, abdominal pain, neutropenia, El Nino years, combined local dry season + global climate variability/El Nino, thrombocytopenia, multi-transfusions, bacteremia, lack of chemotherapy, and mortality. After adjusted for confounders using Cox regression models, only incident HM (HR = 16.8; 95% CI, P< 0.0001), Lack of chemotherapy (HR = 6.9, 95% CI, P< 0.002), and Bacteremia (HR= 4.2; 95% CI, P= 0.020) were the most significant and independent predictors of mortality. A separate analysis for HM patients, the mortality rates did not vary (P> 0.05) across HM sub-types: 71.4% (n= 10/14) in multiple myeloma, 84.3% (n= 15/18) in acute myeloid leukemia, 70% (n= 7/10) in myelodysplastic syndromes, 80% (n= 8/10) in chronic myeloid leukemia, 33.3% (n= 2/6) in acute myeloid leukemia, and 80% (n= 4/5) in acute lymphoid leukemia. Conclusion HM is a major cause of morbidity and mortality with epidemic rates explained by lack of chemotherapy, and recurrent bacteremia among Bantu patients facing aging, climate change, rainy seasons, and lack of palliative care.