Current State of Diagnosis and Treatment of Acute Myeloid Leukemias in Adult Patients in the Republic of Kazakhstan

Abstract

Background. In recent years, the incidence of acute myeloid leukemias (AML) globally has continued to increase. Current approaches to AML treatment remain a challenge for the healthcare in many countries. There are only single studies on the analysis of AML state in adult patients in Kazakhstan. Over the last 10 years in Kazakhstan, no results of AML monitoring in adult patients have been available. Aim. To study the characteristics of clinical course and treatment outcomes in AML in the Central Kazakhstan and in the city of Ust-Kamenogorsk, East Kazakhstan Region. Materials & Methods. The study enrolled 86 AML patients (46 men and 40 women), the median age was 60.5 years (range 19-86 years); 64 (74.4 %) patients were from Karaganda Region, 15 (17.4 %) patients were from Ust-Kamenogorsk, and 7 (8.1 %) patients were from other regions of Kazakhstan. The analysis covered the structure and treatment outcomes in newly diagnosed AML patients within the period from 2018 to June, 2021. Statistical analysis of data was made using SPSS Statistics 23.0. Results. The analysis of diagnostic techniques showed that myelogram and immunophenotyping were used in 98.8 %, cytogenetic assay was made in 18 %, and molecular analysis was performed in 59.3 % of patients. The “7+3” remission induction was administered in 54.6 % of patients, 20.9 % of patients were treated with hypomethylating agents and low doses of cytarabine, and 24.4 % of patients were on palliative and supportive therapy. Out of 47 patients treated with the “7+3” remission induction, complete clinical hematological remission was reached in 29 (61.7 %) patients. Primary resistance was reported in 21.3 % of patients. Early mortality (death within 30 days from the start of induction) rate was 17 %. High-dose cytarabine consolidation (1.5-3 g/m² twice every other day, 2-3 courses) was administered to 75.8 % of patients. All the allogeneic bone marrow transplantations (n = 7) were performed at the National Research Center for Oncology and Transplantology in Nur-Sultan. The median overall survival in the group of standard “7+3” chemotherapy recipients was 11 months (range 1-83 months), and the median disease-free survival was 9 months (range 2-79 months). Conclusion. The study presents the characteristics and short-term outcomes of treatment of adult AML patients in Kazakhstan. The study limitations were a short follow-up period and enrollment of patients only from two regions of Kazakhstan. It is necessary to continue improving the current standards of AML diagnosis and treatment of adult patients.