Predictors Factors of Death during Induction Therapy of Acute Myeloblastic Leukemias (Western Algeria, multicenter experience)

Introduction:

Death during induction therapy remains a problem in the management of acute myeloid leukemia (AML). An estimated 6.1% in adult patients and between 19.3% and 27% in subjects of all ages have died of AML during induction therapy. The purpose of this study is to identify the factors that can lead to death during induction therapy.

Patient and methods:

In this multicenter retrospective study, including the Hematology Services of CHU Tlemcen, EHU of Oran, CHU of Oran, CHU of SBA, EPH of Mascara and HMRU of Oran, from 01/01/2007 to 31/12 / 2017. We have included de novo and secondary AML adult patients and have benefited from conventional chemotherapy (regardless of the type and doses of anthracyclin). However, we have excluded patients with a contraindication to treatment, acute promyelocytic leukemias. The evaluation criterion was the death or the survival during the induction therapy (3 + 7 or 3 + 10 regimens).

A variable was considerated statistically significant if the p value was ≤ 0.05. The measurement of a relationship between a possible variable and the occurrence of death was estimated by the Odds-ratio. The associations were evaluated first by a bi-variate analysis followed by a multivariate analysis using logistic regression, including statistically significant variables at the value ≤ 0.1 in bi-variate analysis. If a continuous variable was statistically significant, the receiver operating characteristic curve ROC was constructed.

Results:

Over the past 11 years, 316 patients were included. These patients received either the 3 + 7 or 3 + 10 regimens. The death rate has been estimated at 11.4% (36 patients). We found that age (p: 0.17), PS ≥2 (p: 0.36), clinical symptoms at diagnosis, secondary AML (p: 0.86), FAB classification, white blood cell count (p: 0.34), anthracyclines doses (Daunorubicin 90 mg / m² and Doxorubicin 45 mg / m² VS Daunorubicin 60 mg / m²) and antibiotic prophylaxis (p: 0, 95) do not affect the mortality rate Table 1. In contrast, the creatinin level ≥ 12 mg / dL (p: 0.02), the LDH level> 700 U / L (p: 0.038) and the albumin level ≤ 35 g / L (p: 0.046), increase the risk of death during induction therapy. Table 1

Conclusion:

Conventional induction therapy can be used in patients over 60 years of age. On the other hand, renal failure, hypoalbuminemia and elevated LDH levels increase the risk of mortality during induction therapy.

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