Factors Affecting Treatment Outcome of Acute Promyelocytic Leukemia in Egyptian Patients

Aim: Acute promyelocytic leukemia (APL) is a peculiar subtype of acute myeloid leukemia clinically and morphologically. To date, only a few studies reported the treatment outcome of APL in developing countries. Thus, we investigated the challenges and factors affecting APL treatment in Egypt. Material and Method: This study included 27 APL patients treated at Kasr Al Ainy Center of Clinical Oncology and Nuclear Medicine (NEMROCK) - Cairo University hospital, Egypt from 2010 till 2014. Results: The mean age at presentation was 35 years, and intermediate and high-risk Sanz scores constituted 44% and 30% of patients, respectively. Complete remission (CR) was achieved by 17 patients (63%), 1 patient had a refractory disease (3.7%), and the response could not be evaluated in 5 patients. No deaths were encountered before treatment, and early mortality rate was 14.8% (n=4). All patients in CR received consolidation therapy, and molecular remission was achieved by 14 patients (82.4%). By December 2015, relapse occurred in 5 patients (29.4%). The median disease-free survival (DFS) was 27.1 months, the mean overall survival (OS) was 84.4 months, and the median OS was not reached. Factors affecting survival included: body mass index (DFS: p-0.012, OS: p-0.009), type of induction regimen (OS: p-0.007), treatment interruption (OS: p-0.035), number of consolidation cycles (OS: p-0.001), duration of maintenance therapy (DFS: p-0.018) and response to salvage therapy (OS: p-0.046). Discussion: Our findings elucidate the challenges met by developing countries owing to limited resources and financial constraints.