Prognostic Factors and Survival in Acute Myeloid Leukemia Cases: a Report from the Northeast of Iran

Association of Leukemia With ABO Blood Group Distribution and Discrepancy: A Review Article

The ABO system is an essential blood group in clinical transfusion medicine implicated in several human diseases. The ABO system has been investigated for over a century, with various studies exploring potential links to disease susceptibility. The study examines the possible relationship between leukemia and the distribution and the ABO blood group system discrepancy. A comprehensive review was conducted on the recommended databases to review the ABO blood groups, their association with leukemia, and the expected changes in blood groups among leukemia patients. The study highlights different kinds of leukemia, such as acute lymphocytic leukemia (ALL), acute myeloid leukemia (AML), chronic myeloid leukemia (CML), and chronic lymphocytic leukemia (CLL), their characteristics, and their relationship with ABO blood groups. The document concludes that studying ABO blood group distributions among leukemia patients showed that the most common blood group in acute leukemia is the A group, while in chronic leukemia, the O group is predominant; more studies are required. This study also confirmed an association between leukemia and ABO blood group discrepancy.

[Prognostic factors and survival in adult acute leukemia in Burkina Faso]

Introduction

Acute leukemia is both a diagnostic and therapeutic emergency. Our study aimed to describe the prognostic factors and survival of adults with acute leukemia in Burkina Faso.

Patients and methods

Cross-sectional descriptive study with retrospective data collection covering a period of 4.5 years (2018-2022) in two university hospitals in Burkina Faso. Were included all patients over 18 years hospitalized for acute leukemia in these sites with a usable medical record.

Results

A total of 42 cases were collected, of which 45% suffered from acute lymphoblastic leukemia and 43% from acute myeloid leukemia. In 12% of cases, acute leukemia was not classified. The average age was 35 ± 15 years, with extremes of 19 and 72 years. 12% of the patients presented an age of poor prognosis. Comorbidities were present in 14% of patients. The deterioration in general condition was fairly constant with 95% of patients at WHO stages 3 and 4. All patients presented with bone marrow failure syndrome and tumor syndrome was found in 45%. Anemia and thrombocytopenia were present in almost all cases. Hyperleukocytosis at diagnosis was present in 28 patients (67%); among them 18 patients (64%) had leukocytes greater than 50 G/L. Death in hospital was found in 38% of patients and loss of sight in 31%. The median survival was 3 months. Survival was 30% at 6 months and 0% at 12 months.

Conclusion

Acute leukemias are in our practice conditions of poor prognosis with a fairly short survival.

Prognostics and Clinical Outcomes in Patients Diagnosed With Acute Myeloid Leukemia (AML) in a Teaching Hospital

Background: Acute myeloid leukemia (AML) is a heterogeneous disease. Prognosis and survival depend on several factors that determine tumor behavior and response to therapy. AML has a poor prognosis that depends on several factors: patient's age, gender, body mass index (BMI), baseline white blood cells count, and bone marrow blast (BMB) cell count at the time of diagnosis. Therefore, this study aimed to determine the prognostic role of these factors and their impact on outcomes, and how these prognostic factors may affect AML patients before and after induction chemotherapy.

Methods: The study design is an observational, retrospective record review. We included records of patients diagnosed with primary and secondary AML who received chemotherapy between 2013 and 2019 at King Abdulaziz University in Jeddah, Saudi Arabia. Data were extracted from medical records, entered into an Excel sheet (Microsoft Corp., Redmond, WA), and analyzed using SPSS Statistics, version 25 (IBM Corp., Armonk, NY).

Results: Forty-two AML patients who were started on chemotherapy were analyzed. The mean age at diagnosis was 35 ± 22.2 years; 52.4% were male. The ability to achieve the first remission varied according to age group; the 21-45 age group had the higher ability and survival rate of 75.0%. On the other hand, the mortality incidence was higher (at 70.0%) in both the 11-20 and the 46-70 age groups. A strong negative correlation was observed between age and survival duration after treatment (SDAT) (r = - 0.618, p = 0.004). The death incidence was increased in the BMI ranges that were under and above the normal weight range. SDAT differed significantly between the three groups in favor of the normal-weight patients (p = 0.019). We found that patients with BMB < 5 had the most deaths. There was a significant negative association between BMB and days to achieve the first remission after treatment (p = 0.033). 

Conclusion: Age, BMI, and BMB are considered effective prognostic factors for AML patients.

Novel combined variants of WT1 and TET2 in a refractory and recurrent AML patient

BACKGROUND

Somatic mutations in Wilms' tumor 1 (WT1) and tet methylcytosine dioxygenase 2 (TET2) genes were separately perceived as contributors to hematopoietic disorders and usually thought to have a mutually exclusive effect in acute myeloid leukemia (AML). However, we found novel WT1 and TET2 variants persistently co-existed in a refractory and recurrent AML patient with t(9;11)(p21.3;q23.3); KMT2A-MLLT3, and were only detectable genetic alteration in early recurrence. Hence, these two novel variants were further investigated in patient's family, and the potential effect on disease progression was evaluated at follow-up.

CASE PRESENTATION

A 27-year-old male was diagnosed with AML, having t(9;11)(p21.3;q23.3); KMT2A-MLLT3, accompanied by WT1 (NM_024426.6:exon7:c.1109G>C:p.Arg370Pro) and TET2 (NM_001127208.3:exon11:c.5530G>A:p.Asp1844Asn) variants. After two cycles of induction chemotherapy, complete remission was achieved. A consolidation treatment was then completed. However, the evaluation of the bone marrow revealed that early recurrence, WT1 (p.Arg370Pro) and TET2 (p.Asp1844Asn) variants still detectable, instead of KMT2A-MLLT3. Subsequently, these two variants were proved to be germline variants, which inherited from father and mother respectively. And the patient's elder brother also carried TET2 (p.Asp1844Asn) variant. A sequential allogeneic HLA-matched sible hematopoietic stem cell transplantation (allo-HSCT) was carried out, and the donor is the patient's elder brother, the original two variants of patient were replaced by the donor-derived TET2 (p.Asp1844Asn) variant after allo-HSCT; the patient has remained in complete remission with regular follow-up.

CONCLUSIONS

In brief, it is firstly reported that WT1 p.Arg370Pro and TET2 p.Asp1844Asn variants co-existed in a refractory and recurrent AML patient by inheritance. These two variants of the patient were replaced with donor-derived TET2 p.Asp1844Asn after allo-HSCT, and the patient has remained in complete remission with regular follow-up.

Types, Clinical Features, and Survival Outcomes of Patients with Acute Myeloid Leukemia in Thailand: A 3-Year Prospective Multicenter Study from the Thai Acute Leukemia Study Group (TALSG)

BACKGROUND

Acute myeloid leukemia (AML) is a common, challenging hematologic malignancy worldwide. Thai data on its characteristics and outcomes have never been systematically reported, to our knowledge. The objective of this study was to determine the clinical features and outcomes of Thai patients with AML.

PATIENTS AND METHODS

This was a prospective observational study of nine academic hospitals. Patients with newly diagnosed AML were invited to register online.

RESULTS

A total of 679 patients with AML were included. The presence of circulating peripheral blood blasts was correlated with a high white blood cell count. Acute promyelocytic leukemia (APL) had predominantly lower white blood cell counts and higher proportions without peripheral blood blasts compared with non-APL AML. Disseminated intravascular coagulation was commonly presented in APL (37.7%). Splenomegaly and normal platelet count were more frequently seen in patients with Philadelphia chromosome-positive AML. The median follow-up time for those who survived more than 1 year was 28.0 months. One-year overall survival rates for non-APL AML and APL were 31.9% and 88.2%, respectively; 2-year overall survival rates were 29.6% and 88.2%, respectively. Hematopoietic stem cell transplantation could improve survival in non-APL AML.

CONCLUSION

APL should be considered despite absence of peripheral blood blast. This study demonstrates poor outcome of Thai AML and more research to improve outcomes are underway. Expanding access to hematopoietic stem cell transplantation should be considered in Thailand.

The Survival of Patients with t(15;17)(q22;q12) Positive Acute Promyelocytic Leukemia: A Study in North-East of Iran

Background & Objective

Acute promyelocytic leukemia (APL) with t(15;17)(q22;q12) is a relatively common subtype of acute myeloid leukemia (AML). Here, our objective was to ascertain the survival of patients with this leukemia in north-east of Iran.

Methods

Survival rates of 42 APL patients with t(15;17)(q22;q12) were assessed. Clinical information was obtained from archived medical records. Statistical analysis was performed by SPSS 18 software using log-ranked test and Kaplan Maier survival analysis.

Results

Females and males comprised 49% and 51%, respectively. The mean age at diagnosis was 34.3 ± 14.1 years old. During the study period, 17 demises occurred in males, while this number was 7 in females. The mean survival of patients (month) was 23.22 ± 3.57 (95% CI: 16.21 ± 30.2). The five-year survival rate obtained 30%. Regarding demographic and clinical features, the highest rates of 5-year survival were recorded in patients with 20-35 years old (47.6%), males (51%), white blood cell count <10 × 10 9 /l (48%), and platelet count >140 × 10 9 /l (100%).

Conclusion

Younger age, lower WBC count and higher platelet count were significantly associated with longer survival in AML patients with t(15;17)(q22; q12).

Myeloid Leukemias: A Glance at Middle Eastern Centers

BACKGROUND AND OBJECTIVES

Myeloid leukemias (MLs) are clonal stem cell disorders affecting myeloid lineage cells. Advances in cytogenetic and molecular studies partially disclosed the mystery about risk factors and pathophysiology of MLs. Regarding incidence, risk factors, response to treatment, and overall survival of patients, research showed differences among different countries. However, the Western registry data are the basis for the documented description of MLs in medical textbooks. This research aimed to study MLs in Middle Eastern health centers. Egypt has the highest population in the Middle East; furthermore, 96.6% of the population is native Egyptians; accordingly the study focused on Egypt.

PATIENTS AND METHODS

Data of 468 patients with MLs were collected from hospital records at two big tertiary health centers. They were grouped into group 1 (chronic myeloid leukemia, CML) and group 2 (acute myeloid leukemia, AML); the latter was subgrouped into 2a (primary AML) and 2b (secondary AML).

RESULTS AND CONCLUSIONS

The median age of patients was 43 years; males predominate in group 2a and females in groups 1 and 2b. 37.2% of group 1 patients were treated with Gleevec. Hematopoietic stem cell transplantation was planned for only 5% of group 2 and 18% relapsed. Of groups 1 and 2 patients, 25% and 12%, respectively, stopped follow up, and 15% and 35% died. ORR and overall survival were 53%, 27% and 7%, 0.4% for groups 1 and 2, respectively. Conclusively, this study showed a young age of ML patients, with female predominance in CML, and poor outcome. This reflected racial, ethnic and risk factor differences in incidence of MLs.

5-year survival rates based on the type of leukemia in Iran, a Meta-analysis

Background:

According to epidemiological studies, leukemia is among the five most common cancers in Iran. Keeping efforts to estimate survival is critical to monitoring and improving patients’ quality of life with leukemia. The purpose of this study was to evaluate the 5-year survival rate of leukemia patients in Iran using meta-analysis method.

Methods:

This meta-analysis was carried out according to studies that adhere to inclusion and exclusion criteria during enrolment. The valid Iranian databases included: Medex, Magiran, SID, and Medlib, along with international data bases, namely, Scopus, Pubmed, and ISI were searched to find relevant articles. After determining the heterogeneity between studies, the random effects models were used to estimate pooled survival in leukemia patients.

Results:

In total, 18 studies involving 2517 participants were included in this meta-analysis. The pooled 5-year survival rate was 0.56 % (95% CI, 0.54 to 0.58). According to types AML and ALL, the 5-year survival rates in Iran were 35.0 % (95% CI: 32.0-38.0) and 57.0 % (95% CI: 54.0-60.0), respectively.

Conclusion:

Based on our findings, slightly less than 50% of leukemia deaths happened in the first 5 years after diagnosis, which is lower than the global average.