Survival of Acute Myeloid Leukaemia Patients- A Retrospective Study from the Yopougon University Hospital, Abidjan, Ivory Coast

Abstract

Introduction: The survival of acute leukaemia patients has improved significantly thanks to multidrug chemotherapy and the development of cell therapy and marrow transplantation. However, this is not the case in Middle Income Countries (MICs), particularly in Côte d’Ivoire, West Africa where much efforts are still needed to improve the treatment of these patients.This study raises the issue of the fate and survival of Acute Myeloid Leukaemia (AML) patients in these countries. Aim: To study the overall survival and survival factors of patients with AML under the present practice conditions. Materials and Methods: This retrospective study was conducted in the Department of Haematology of Yopougon University Hospital in Abidjan, Ivory Coast. The data was collected from January 2005-April 2019 and data processing happened over a duration of one year from November 2019-November 2020. The mortality and survival were studied on 75 AML patients.The socio-demographic, pretherapeutic and therapeutic characteristics were recorded. Statistical Package for the Social Sciences (SPSS) statistics version 26 was used for data analysis, comparisons were done using by the Chi-square test and survival through the Kaplan Meier method and the log rank test. Results: The patient’s age ranged from 1 to 74 years, with two peaks (37 and 49 years old) with a sex ratio at 1.03. Majority of patients (50.7%) had a low socio-economic level. Overall, 81.6% of patients started treatment within two weeks. Out of total patients 38 (50.7%) patients received chemotherapy, which was curative for 10 (13.33%) patients and palliative for 28 (37.33%) patients. There was not a single patient of complete remission. A total of 4 (5.3%) were alive, 51 (68%) died, and 10 (26.7%) were lost to follow-up. The average overall survival (OS) was 90 days and the probabilitý of Overall Survival (OS) was 62% at one month, 49% at six months, and 10% at one year. The predictive factors for prolonged survival were high socioeconomic level (p=0.046) - absence of bleeding syndrome (p-0.04) - haemoglobin level ≥10 g/dL (p-0.02) - cytological type different from AML-M0 (p-0.05). Conclusion: The therapeutic results were inferior to those obtained in developed countries where high level diagnostic and therapeutic techniques give very promising results. This study highlighted the difficulties of AML management and identified five prognostic factors of survival in the care conditions of MIC.