Title

Poster # 052 Risk stratification and outcomes based on cytogenetic profile in acute myeloid leukemias in Pakistan

Document Type

Article

Department

Paediatrics and Child Health; Haematology/Oncology; Pathology and Laboratory Medicine

Abstract

Background: Acute myeloid leukemia (AML) is a heterogeneous disease from morphologic, cytogenetic, immunophenotypic, molecular, and clinical perspectives. AML accounts for15% to 20% of all childhood leukemia. Cytogenetic and molecular data are recognised as the most valuable prognostic factors in AML. Most of the studies on cytogenetic profiling of AML are from Western countries and similar data from lower-middle-income countries is lacking. We conducted this retrospective study at a single cancer centre in Pakistan.
Objectives: To study the cytogenetic etiology in AML and its association with treatment outcomes in pediatric patients at Aga Khan University Hospital in Karachi, Pakistan.
Design/Method: Patients from birth through 18 years diagnosed from 2006 to 2017 with AML were analysed for demographics, presenting complaints, cytogenetic profiles, management plan, toxicity and treatment outcomes.
Results: The cohort included 176 patients. A total of 103 patients were excluded due to incomplete data. Seventy-three patients met the inclusion criteria with median age of 13 years IQR (4-16 months). Forty-four (60%) patients were male. Fever (n = 56, 80%) was the most common presentation. From the risk stratification groups, 23 (32%) were Favorable, 36 (49%) were Intermediate, and 14 (19 %) were Adverse. Gum Hypertrophy (n = 3, 4%, p = 0.58) was seen in Intermediate and Adverse whereas Chloroma (n = 3, 4%, p = 0.031) was seen in Favorable, showing significant difference in risk group presentation. Forty-five (62%) were treated on Cytarabine, Daunorubicin, Etoposide protocol, 9 (12%) on Cytarabine and Daunorubicin, and 9 (12%) did not receive treatment. Chemotherapy toxicities included Cardiotoxicity (n = 14, 19%) and Neurotoxicity (n = 2, 3%). The median follow-up period was 9 months. Five-year overall survival for Favorable risk: 40% (95% CI: 5% - 76%), Intermediate risk: 38% (95% CI:19% - 57%), and Adverse risk: 49% (95% CI: 18% - 80%). The 5-year Event-Free Survival keeping relapse as an event for Favorable risk: 85% (95% CI: 66% - 104%), Intermediate risk: 57% (95% CI: 32% - 82%), and Adverse risk: 58% (95% CI: 22% - 94%).
Conclusion: Our results suggest that risk stratification based on cytogenetic etiology did not correlate with survival outcomes. This suggests that lower survival rates in our population are not due to primary disease but possibly due to higher rates of toxicity and complications.

Publication

Pediatric Blood & Cancer

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