Management of acute myeloid leukaemia--5 years experience at Armed Forces Bone Marrow Transplant Centre, Rawalpindi.
OBJECTIVE
To evaluate the outcome in denovo AML patients treated with different remission induction and consolidation chemotherapy regimens in our population.


METHODS
A retrospective study on acute myeloid leukaemia (AML) patients was carried out at Armed Forces Bone Marrow Transplant Centre Rawalpindi Pakistan between July 2001 and June 2006. During 5 years period 46 patients received treatment for AML at our centre. Twenty nine patients were males and 17 were females. Median age of patients was 21 years (range: 7-56 years). These 46 patients were categorized into two groups on the basis of type of leukaemia and chemotherapy given. In group-I 40 patients (group Ia: 23 patients of M1-M6, less M3 group Ib: 17 patients of AML M3) received anthracycline and cytarabin based chemotherapy. In group-II, six patients (AML- M3) received all trans retinoic acid (ATRA) based chemotherapy.


RESULTS
In group Ia, out of 23 patients, 14 patients (60.8%) achieved complete remission (CR) after remission induction chemotherapy, 10 patients remained in CR after 3rd and 4th consolidation. Eleven patients died and five patients relapsed during treatment and follow up. In this group overall CR, relapse rate (RR) and mortality was 30.4% (7/23), 21.7% (5/23) & 48% (11/23) respectively. In group Ib out of 17 patients, 9 patients (53%) achieved CR after remission induction. Eleven patients died during treatment while one patient relapsed in this group. Overall CR, RR & mortality was 29.4% (5/17), 6% (1/17) & 55% (11/17) respectively. In group II all patients achieved CR (100%) after 1st course of chemotherapy. Two of these patients unfortunately died of uncontrolled sepsis during 1st consolidation, while remaining 4 patients 66.6% are on maintenance chemotherapy and are still in CR.


CONCLUSIONS
Overall CR, RR and mortality in all groups was 35% (16/46), 13% (6/46) and 52% (24/46) respectively at a median follow-up of 36 + 8 months. Survival in AML-M3 patients treated with ATRA based chemotherapy is significantly superior than anthracycline based chemotherapy (66.6% vs. 29.4%). Infection and chemotherapy toxicity being major causes of mortality.
Ullah
Khalil
K
Department of Haematology, Armed Forces Bone Marrow Transplant Centre, Rawalpindi, Pakistan.
Ahmed
Parvez
P
Raza
Shahid
S
Satti
Tariq Mahmood
TM
Chaudhry
Qamar-Un-nisa
QU
Akhtar
Fahim
F
Kamal
Muhammad Khalid
MK
Akhtar
Farrukh Mahmood
FM
Khan
Badshah
B
D000293:Adolescent; D000328:Adult; D018943:Anthracyclines / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002648:Child; D003561:Cytarabine / Q000627:therapeutic use*; D018450:Disease Progression; D005260:Female; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D008887:Military Medicine; D008889:Military Personnel; D010154:Pakistan; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014212:Tretinoin / Q000627:therapeutic use*
D018943:Anthracyclines; D000970:Antineoplastic Agents; D003561:Cytarabine; D014212:Tretinoin