Frequency of Induction-Related Mortality in Patients of Acute Myeloid Leukemia - Experience from a Resource Limited Country

Abstract

Aim: Treatment-related mortality during remission induction (also known as induction-related mortality) is a significant contributing factor to poor outcome of acute myeloid leukemia (AML) patients. This is true especially for resource limited countries where there is dearth of adequate supportive care. This study is carried to analyze the frequency of induction mortality in AML patients in Pakistan and the factors that contribute to it.     Methodology: This descriptive case series was conducted in AML patients admitted in INMOL Hospital, Lahore from November 2017 to April 2018. 80 Patients aged 5-50 years of age with de-novo AML were included in the study. Their progress over 28 days following start of induction chemotherapy, including complications experienced and the outcome at end of 28 days was observed. All patients received prophylactic anti-fungal therapy as part of supportive care. Results: The progress and outcomes of 80 patients were analyzed including 8 patients less than 15 years of age and 4 patients of acute promyelocytic leukemia. The induction-related mortality was 27.5% (n=22). Of the patients alive at the end of 28 days of start of induction, 38 achieved complete morphological remission (65.5%). Poor performance status was associated with higher induction mortality (P = .01). The cause of death in 90% of the patients was sepsis and fulminant infections. Conclusion: The frequency of induction mortality in our population was 27.5%. This is a significantly high number when compared with data from the developed resource abundant countries. Thus it highlights the importance of allocation of increased resources to provide adequate supportive measures and infection control for this population.