Why adult patients with acute leukemias are dying in the developing world: The other side of the coin.

Abstract

e19035 Background: Majority of the patients with acute leukemias can reach complete remission (CR) in case of appropriate therapy and many of those in CR are expected to remain in remission for several years, which could be considered a cure. Because of progress in recent decades, less and less patients in the developed world are dying. In the developing world the situation is different and with the current work we would like to report the state of leukemias in Armenia and significant disparities, which affect the treatment outcomes of those patients. Methods: We analyzed the medical records of all expired adult patients diagnosed with acute leukemia at the Hematology Center of Armenia from 01/01/2016 until 12/31/2020. Hematology Center is the only institution in Armenia treating leukemias, meaning the data is a countrywide report. Death dates were taken from the United Information System of Electronic Healthcare in the Republic of Armenia. Results: Over the five-year period, 431 patients were diagnosed with AL, of which 310 (71.9%) died. 244 medical records were available for further analysis. The median age of patients at the time of diagnosis was 59 (18-85), 45.9% (112) were female. 23.8% (58) of patients died before starting chemotherapy, of which 44.8% (26) refused the treatment, the others died from different complications due to disease progression. 33.6% (82) patients reached CR of which 29.3% (24) died in first remission: 3 pts from acute heart failure, 1 from COVID-19, 3 from septic shock, 1 from pulmonary aspergillosis, 2 from acute respiratory failure, in 14 patients the causes of death were unknown. 58(70.7%) of those patients, who developed relapse, only 12% (7) of them reached 2nd remission. In 82.8% (48) of patients the death was because of disease progression. One patient died from acute kidney failure, 1 from acute respiratory failure, 1 from COVID-19,1 from septic shock. 50 patients died during induction therapy, form which 58% (29) was due to disease progression, the other reasons were: septic shock, acute heart failure, brain hemorrhage, acute respiratory failure, mesenteric venous thrombosis, multiple organ failure. 30 patients were resistant to the first line therapy and refused further therapy. In 24 patients it was not possible to clarify if they have developed remission and what were the death causes. Conclusions: In our analyzed cohort 23% of all patients refused the treatment, almost half of which did not even start the treatment. It should also be mentioned that because of stigma about cancer, some of those patients did not know their diagnosis and the decisions were made by the relatives. Other reasons for such high abandonment rates are mostly financial and social.