Characteristics, survival and prognostic factors of adult patients with acute leukemia at the Uganda Cancer Institute

Abstract

Background: Acute leukemias are rapidly progressive hematological malignancies associated with substantial morbidity and mortality, particularly in the adult population. In the past few decades, there is an increasing incidence of leukemia across the global However, large disparities exist between resource rich settings and resource limited settings in incidence, short- and long-term outcomes of this disease. This may be explained in part by the varied clinical characteristics and the uneven distribution of prognostic factors. Objective: The objective was to describe the clinical characteristics, survival and prognostic factors in adult patients with acute leukemia registered at the Uganda Cancer Institute (UCI) between January of 2009 and December of 2019. Methodology: A retrospective cohort study design was used. Patients aged 18 years and above with a cytopathological diagnosis of acute leukemia were included. Data was extracted on clinical and laboratory characteristics, response to treatment and survival. The Kaplan Meier survival analysis was used to calculate the yearly event probabilities, median survival time and overall survival rate. Factors associated with survival were analyzed using bivariate and then multivariate analysis through the Cox-proportional hazards regression mode. STATA version 16.0 was used for data analysis. P<0.05 was considered statistically significant. Results: Two hundred forty one charts of adult patients meeting eligibility criteria for the study were retrieved. The most prevalent diagnosis was acute myeloid Leukemia (56.3%), majority of the patients were male (60.5%) and median age was 32 years. Survival after diagnosis with acute leukemia was poor; overall survival at one month was 60.3% (95% CI: 53.4% - 66.5%); at one year was 17.1% (95% CI: 12.3% - 22.5%) and at five years was 2.0% (95% CI: 0.4% - 6.0%). Factors significantly associated with survival included sex, HIV status, body mass index, ECOG score, chemotherapy treatment, and treatment response after induction chemotherapy. Conclusion: In this study, majority of the patients were male, less than 35 years old, presenting with fever, general weakness and weight loss. The most common diagnosis was AML. At the UCI, acute leukemia overall survival is poor (OS at 1, 2, 5year at 17.1%, 7.5% and 2.0% respectively). Being female, over- or underweight, having a poor ECOG score, failure to achieve complete remission after induction chemotherapy are factors associated with poor outcome of acute leukemia. We propose prospective studies to better understand causes of early mortality and poor overall survival among acute leukemia patients in Uganda