Clinico-Pathological Profile and Outcome of Acute Myeloid Leukemia: An Experience of Al-Amal Hematology/Oncology Center In Qatar

Abstract 4384

AML is a group of neoplastic disorders resulting from clonal expansion of immature hematopoietic cells in the bone marrow, blood and other tissues. AML represents approximately 90% of all acute leukemias in adults. The median age at diagnosis is 65 years. Geographic variations in the incidence and subtype of AML have been reported in different parts of the world. The classification of AML has evolved from the standard morphological FAB classification to the most recent 2008 World Health Organization (WHO) classification that consider the morphological, immunological, cytogenetic, genetic, and clinical features. In this study we report and for the first time from Qatar the clinico-pathological features and the outcome of adult patients diagnosed as AML between January 2006 and January 2010 at Al-Amal Oncology/Hematology Center. Diagnosis was based on combined morphologic, immunophenotypic & cytogenetic studies. Seventy three patients were found to have AML accounting for 73% of all adult acute leukemias diagnosed in our center. Age was between 17 and 100 years with a median age of 40 years. Fifty five patients were males and 18 were females with a male to female ratio of 3:1. Most of the patients were non-Qatari (83.5%). The most common FAB subtype was AML –M2 (27.3%). The second most prevalent is AML-M3 (23.2%). Within this group (17.7%) were of the classical hyper granular type, while (82.3%) showed different morphological variants. Cytogenetic analysis was attempted in 64 cases. Intermediate was the most common cytogenetic risk group (64%). The most common clinical presentations were Bleeding tendency (55 patients), symptomatic anemia (52 patients) and fever (29 patients). Fifty patients were treated in our center in Qatar. Pre-treatment death occurred in 14 patients (8 patients presented with septic shock and 6 with intracranial haemorrhage). Three patients were initially palliative, 33 patients received treatment in forms of 2 inductions with Doxorubicin + Cytosine Arabinoside (DA 3+7) and 3 consolidations with Cytosine Arabinoside, pre-treatment required in 13 patients, 2 of them required leukopharesis and 11 underwent cyto-reduction by hydroxy-carbamide. Complete remission was achieved in 28 patients (85%), and 5 patients were resistant disease. Patients were followed from 60 to 1620 days with average of 429 days and Median of 330 days. As of June 2010, 24 (73%) patients are still alive, and 9 (27%) patients died. Infection was the main cause of death. In conclusion AML in Qatar have a lower median age, and an increase incidence of AML-M3 (Acute Promyelocytic) subtype that exhibit significant morphological heterogenecity (variant APL). Doxorubicin is still in use for induction in our center due to unavailability of other anthracyclines. Despite this, cardiac toxicity was not seen in our cases so far, and our complete remission and disease free survival are comparable to international data.