Background: Recent advances have led to higher response rates and improved survival in patients with newly diagnosed acute myeloid leukemia (AML). However, early death, remain important challenges.
Aims: The aim was to explore risk factors for early mortality in adult AML patients in Southern Tunisia.
Methods: Our study is retrospective over 15 years (2005-2019). Patients included (age: 20- 60 years old) were diagnosed with de novo AML, diagnosed in the clinical hematology department of Hedi Chaker Sfax Hospital / TUNISIA. Secondary leukemia and FAB m3 were excluded. We assessed the one-month mortality in these patients.
Results: One hundred seventy-seven patients with newly AML were in indication of treatment with intensive CT. Thirty-seven died early (21%). The factors that significantly influence the rate of ED are age, gender, delay in diagnosis and the presence of disseminated intravascular coagulation (DIC) (Image/Table).
Death before the start of CT was found in 6 cases (16%) with a median time between diagnosis and death of 5 days [2-28]. Respiratory distress was the only cause of death before treatment, which was caused by intra-alveolar hemorrhage, pulmonary leukocytosis and hypoxemic infectious pneumonitis in 3, 2 and 1 case respectively.Thirty-one patients (84%) died during the induction cure with a median time between the start of the cure and death of 17 days [2-29]. The causes of death during the induction cure were multiple. Death by respiratory distress in 15 cases (48%) originating from: intra-alveolar hemorrhage, PAO and hypoxemic infectious pneumonitis in 7, 4 and 4 cases respectively. Severe sepsis was the cause of death in 11 cases (35%). In the remaining 5 cases the cause of death was: compressive pericardial effusion (2 cases), cerebral hemorrhage (1 case), hyperosmolar coma (1 case) and status epilepticus (1 case).
Image:
Summary/Conclusion: The ED rate in our series is higher than those described in the literature (21% vs 5-10%). Advanced age, gender, delay in diagnosis and initial DIC were the risk factors for ED in our study. Death most commonly occurs from infectious or bleeding complications related to cytopenia. Early diagnosis of AML and improve supportive care is essential to reduce the ED rate and improve overall survival by establishing early treatment