AML-295: Clinical Characteristics and Outcome of Acute Leukemia in Lebanese Patients: A Retrospective Observational Analysis

Abstract

Context: The molecular characteristics of AML disease remain widely unknown in Lebanon. Cytogenetics and molecular testing in AML are becoming routine practice for disease classification and prognosis. Objective: Our aim was to describe patients’ characteristics and outcome, investigating the association between karyotype on diagnosis, and survival in the Lebanese population. Design: Medical records were retrospectively reviewed for AML patients diagnosed between January 2008 and December 2018. The last update of the data was done in February 2019. Setting: Patients included were treated at Mount Lebanon Hospital University Medical Center or Hotel-Dieu de France University Hospital. Patients: 54 patients were included. Inclusion criteria comprised patients diagnosed with AML and receiving treatment, and availability of data on all sequences of therapy. Patients diagnosed with AML-M3 were not included in the study. Treatment: Fit patients received induction therapy as high dose cytarabine + anthracycline. Then if complete remission: consolidation as cytarabine. Older unfit patients received hypomethylating agent azacytidine. Results: 53.7% were male, median age was 57.06 years at diagnosis. According to FAB classification, the majority (18.5%) were AML-M4, the least (1.9%) M6 and 24.1% were non identifiable. 74.1% were de novo and 16.7% were post-MDS with azacitidine as the major culprit drug. 9.7% were secondary to solid tumors. On diagnosis, 22.6% had hyperleukocytosis and 28.6% were in aplasia. 41.5%, 13.2% and 5.7% were respectively in the intermediate, high, and low risk group. FLT3 was positive in 7.5% of tested cases and NPM1 in 3.8%. No patient was found to have t(16;16) or inversion 16. PML-RARA was positive in 7.5% of patients. 54.7% achieved complete remission, 7.5% were in partial remission and 32.1% were primary refractory. 82.75% relapsed after remission. DFS was 18.4 months with a median OS of 17.8 months ranging from 10.6 months for high-risk group and 20.4 months for the low-risk group. No significant statistical correlation was found between karyotype on diagnosis and survival [P =0.4]. Conclusion: Our study is the first to describe AML characteristics in Lebanon. Multicenter studies are needed to clarify if the Lebanese population has the same molecular and survival pattern as others described in international data.