Acute myeloid leukemia: Does one size fit all? A retrospective analysis of outcomes of therapy at Moi Teaching and Referral Hospital in Eldoret, Kenya.

Wanjiku, Christopher Mwaniki; Saliba, Antoine N.; Njiru, Evangeline

doi:10.1200/jco.2018.36.15_suppl.e18529

Cited by 2 publications

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“…In a small study of 20 patients with AML receiving low-dose cytarabine in Kenya, only 64.7% (n = 11) of patients completed one full cycle of treatment and 75% (n = 15) died within 1 year of diagnosis. 34 Still, in Kenya, a larger study of 113 patients with AML whose median age was 40 years and in which no patient received standard intensive induction chemotherapy because of inadequate supportive care showed that the median overall survival after diagnosis was only 45 days. 10 Another study showed that although toxicity was acceptable with the use of a low-intensity regimen among children with ALL, more than 70% of patients had died at 2 years and disease relapse was a substantial cause of failure.…”

Section: Discussionmentioning

confidence: 99%

One-Year Survival and Prognosticators of Adults With Acute Leukemia at the Uganda Cancer Institute

Natukunda

Omoding

Bongomin

et al. 2023

JCO Global Oncology

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PURPOSE Acute leukemias are associated with substantial morbidity and mortality, particularly in the adult population. Despite an increasing burden of acute leukemia in developing countries, there are limited data on clinical outcomes and prognostic factors in this setting. In this study, we aimed to describe the clinical characteristics, survival, and prognostic factors of adults with acute leukemia at the Uganda Cancer Institute (UCI). METHODS A retrospective cohort study was conducted between January 2009 and December 2018, reviewing data of patients 18 years or older with a cytopathologic diagnosis of acute leukemia at UCI. Data were extracted on clinical and laboratory characteristics, response to treatment, and survival. Cox-proportional hazards regression and survival analysis were performed to determine survival rates and associated factors. P < .05 was considered statistically significant. RESULTS In total, 233 participants were enrolled. Most (59.2%. n = 138) participants were male, with a median age of 32 years (IQR, 23-48 years), and 136 (58.4%) had AML. Overall, the 1-year survival was 16.5%, with a median survival time of 47 (IQR, 21-219) days. Predictors of mortality were being a female (adjusted hazard ratio [aHR], 2.8; 95% CI, 1.2 to 6.7; P = .022) and overweight (aHR, 4.2; 95% CI, 1.3 to 13.4; P = .015). Among the patients who had AML, the predictors were poor Eastern Cooperative Oncology Group (ECOG; aHR, 3.1; 95% CI, 1.6 to 6.2; P = .001) and HIV (aHR, 6.0; 95% CI, 1.7 to 20.5; P = .004). Among the patients who had ALL, the predictors were poor ECOG (aHR, 2.3; 95% CI, 1.3 to 4.1; P = .006). CONCLUSION Patients with acute leukemia in Uganda have poor overall survival. Prospective studies are recommended to better understand causes of early mortality.

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Section: Discussionmentioning

confidence: 99%

One-Year Survival and Prognosticators of Adults With Acute Leukemia at the Uganda Cancer Institute

Natukunda

Omoding

Bongomin

et al. 2023

JCO Global Oncology

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“…Latest Globocan data estimates that in Kenya, the incidence rates of leukemia are 4.8 and 4.5/100,000 in men and women respectively and is listed among the top ten causes of cancer mortality ( World Health Organization, 2020 ). Despite an increasing disease burden in Sub-Saharan Africa, there is limited infrastructure and finances that deters the use of recommended genetic testing ( Gopal et al, 2012 ; Wanjiku et al, 2018 ). Cytogenetic and molecular techniques, which are core elements of diagnosis in the developed world, are nonexistent in most Sub-Saharan countries ( Gopal et al, 2012 ).…”

Section: Introductionmentioning

confidence: 99%

Molecular Profiling of Kenyan Acute Myeloid Leukemia Patients

et al. 2022

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Acute myeloid leukemia (AML) is an infrequent disease, and it is associated with high morbidity and mortality. It harbors a unique configuration of cytogenetic abnormalities and molecular mutations that can be detected using microscopic and molecular methods respectively. These genetic tests are core elements of diagnosis and prognostication in high-income countries. They are routinely incorporated in clinical decision making, allowing for the individualization of therapy. However, these tests are largely inaccessible to most patients in Kenya and therefore no data has been reported on this group of patients. The main purpose of this study is to describe the cytogenetic and molecular abnormalities of acute myeloid leukemia patients seen at the hemato-oncology unit of Kenyatta National Hospital. A cross-sectional descriptive study was carried out over a 3-month period on ten patients with a diagnosis of AML. Social demographics and clinical data were collected through a study proforma. A peripheral blood sample was collected for conventional metaphase G-banding technique and next generation sequencing. Particularly, targeted DNA sequencing (Illumina myeloid panel) and whole exome sequencing (WES) were performed. Cytogenetic analysis failed in 10/10 cases. Targeted sequencing was successfully obtained in 8 cases, whereas WES in 7. Cytogenetic studies yielded no results. There were 20 mutations detected across 10 commonly mutated genes. All patients had at least one clinically relevant mutation. Based on ELN criteria, NGS identified three patients with high-risk mutations, affecting TP53 (n = 2) and RUNX1 (n = 1). One patient was classified as favorable (PML-RARA) while 4 were standard risk. However, WT1 mutations associated with unfavorable prognosis were recorded in additional 2 cases. WES showed concordant results with targeted sequencing while unveiling more mutations that warrant further attention. In conclusion, we provide the first molecular profiling study of AML patients in Kenya including application of advanced next generation sequencing technologies, highlighting current limitations of AML diagnostics and treatment while confirming the relevance of NGS in AML characterization.

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Acute myeloid leukemia: Does one size fit all? A retrospective analysis of outcomes of therapy at Moi Teaching and Referral Hospital in Eldoret, Kenya.

Cited by 2 publications

References 0 publications

One-Year Survival and Prognosticators of Adults With Acute Leukemia at the Uganda Cancer Institute

One-Year Survival and Prognosticators of Adults With Acute Leukemia at the Uganda Cancer Institute

Molecular Profiling of Kenyan Acute Myeloid Leukemia Patients

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