Chepsy, C Philip (2014) A Prospective study of the Demographic profile and Clinical outcomes of Newly Diagnosed patients with Acute Myeloid Leukemia at Our Centre. Masters thesis, Christian Medical College, Vellore.
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Abstract
INTRODUCTION : Acute myeloid leukemia (AML) is a heterogeneous clonal disorder of haematopoietic progenitor cells unable to differentiate and respond to normal regulators of proliferation. The standard of care in treatment has remained induction chemotherapy with anthracycline and cytosine followed by consolidation. In adults with acute myeloid leukemia (AML), intensive chemotherapy achieves complete remission (CR) rates ranging from 50% to 80%. Despite these encouraging results, the majority of patients with the diagnoses who present at our centre do not receive conventional therapy. Recent progress into the biology of the disease has involved dose modifications within the current standards of care .These improvements though significant might not contribute into improving treatment outcomes in a resource restricted economy like ours where costs of therapy are unaffordable to the majority. In an earlier study from our centre it was recognized that only 20 % of patients with AML proceed to receive conventional therapy. We need to identify factors which influence treatment decisions and outcomes in addition to dose modifications to be socially relevant. AIM AND OBJECTIVES : 1. Study the incidence and demographic profile of newly diagnosed adult acute myeloid leukemia at our centre 2. Evaluate treatment and clinical outcome of the patients treated at our center. MATERIAL AND METHODS : Newly diagnosed patients at the department of clinical haematology were administered a questionnaire at presentation. Patients proceeding with therapy were prospectively followed up and outcomes noted. Patients who did not proceed with treatment were re-interviewed subsequently to confirm status and treatment. Descriptive statistics were calculated for all variables. Differences in proportions were assessed using the χ2 or Fisher exact statistic. Differences in means were tested using a Mann-Whitney-U test or t-test as appropriate. The probability of survival was estimated with product-limit method of Kaplan and Meier for overall survival and event-free survival and compared by the log-rank test. RESULTS : There were 318 newly diagnosed patients were evaluable for the study. The median age at presentation was 40(1-79) years. 95 (29.9%) patients proceed to treatment.148 (69.2%) patients had AML with intermediate cytogenetic risk. 174(81%) patients did not proceed with treatment due to inability to finance the costs of therapy. CR/CRi was achieved in 13(59.1%), 37(58.7%) and 1(10.0%) patient in the paediatric, adult and elderly group respectively; (P=0.005). The most common organism in the blood cultures with isolates were [GNB] gram negative bacilli [37(39%)]. The one year overall survival in those treated, was 58.7% ± 6.0% at a median follow up of 3 months. CONCLUSIONS: The median age of patients with AML noted in our study is three decades earlier than that reported in the literature. The inability to finance treatment costs and inability to accompany the patient for the duration of therapy are the main reasons in declining therapy identified in our study. Another major concern is the incidence of infections both bacterial and fungal, higher than reported in literature with invasive fungal disease is present in greater than 50% of individuals who die during induction.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Demographics ; Acute myeloid leukemia ; Treatment. |
| Subjects: | MEDICAL > Clinical Haematology |
| Depositing User: | Subramani R |
| Date Deposited: | 16 Aug 2017 00:40 |
| Last Modified: | 16 Aug 2017 03:49 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/1792 |
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