Low survival in younger adults with Acute Myeloid Leukemia (AML) in Tanzania linked to high disease burden and socioeconomic factors.

BACKGROUND

Acute Myeloid Leukemia (AML) accounts for 20-25% of all leukemia diagnosed worldwide. According to Globoccan 2020, leukemia ranked the 15th most prevalent cancer with an estimated 474,519 new cases and 311,594 deaths annually. However, due to scarcity of well documented cancer registries, epidemiological and survival data of patients with AML is lacking in many African countries, including Tanzania. Therefore, the primary objective of this study was to determine the clinical features, laboratory characteristics and survival outcomes of AML patients treated with different regimens in Tanzania.

METHODS

Data from all adult patients diagnosed with AML at Muhimbili National Hospital (MNH) between January 2018 and December 2023 were analyzed in this retrospective study. STATA version 16 was used for data analysis. The survival outcome was calculated using the Kaplan-Meier method. To evaluate the statistical significance of the results, a p-value cut-off of 0.05 was used. The Cox proportional hazards model was used to identify predictors of survival and to estimate the effect of covariates on the hazard of death. Kruskal Wallis was used to compare the median values for laboratory results and pairwise comparison of median laboratory values was done using the Dunn Test.

RESULTS

A total of 245 patients were diagnosed with acute leukemia during the five-year period (2018-2023), of which 169 (68%) had AML. The mean age at diagnosis was 47.2 (SD ± 18.5) years. Majority of the patients were females (60.7%), and had de novo AML. Most of the patients presented with symptoms of anemia (98.2%) and fever (79.5%). The median survival time was 81 days with a one-year overall survival probability of 15.2%. Patients that resided outside of the Dar es Salaam region had a 74% increase hazard of mortality compared to those living within the Dar es Salaam region (aHR: 1.74, 95% CI: 1.15-2.64, p = 0.008). Patients receiving any form of chemotherapy had a 39% lower hazard of mortality compared to those who were on supportive treatment alone (aHR: 0.61, 95% CI: 0.40-0.93, p = 0.022).

CONCLUSION

AML is the most common acute leukemia among adults in Tanzania, primarily affecting young females under 50 years. Resource constraints and limited treatment options result in poor outcomes, with a median survival of 81 days and one-year overall survival of 15.2%.