Outcomes of Acute Myeloid Leukemia Patients Presenting in a Tertiary Care Hospital: A Developing Country Experience

Afsheen Liaqat; Hira Tariq; Sidra Zafar; Raheel Iftikhar; Tariq Ghafoor; Maryum Khan

Authors

Afsheen Liaqat Department of Clinical Hematology and Bone Marrow Transplant, National University of Medical Sciences, Rawalpindi, Pakistan
Hira Tariq Reasearch officer, Department of Clinical Hematology and Bone Marrow Transplant, National University of Medical Sciences, Rawalpindi, Pakistan
Sidra Zafar Department of Clinical Hematology and Bone Marrow Transplant, National University of Medical Sciences, Rawalpindi, Pakistan
Raheel Iftikhar Department of Clinical Hematology and Bone Marrow Transplant, National University of Medical Sciences, Rawalpindi, Pakistan
Tariq Ghafoor Department of Clinical Hematology and Bone Marrow Transplant, National University of Medical Sciences, Rawalpindi, Pakistan
Maryum Khan Department of Clinical Hematology and Bone Marrow Transplant, National University of Medical Sciences, Rawalpindi, Pakistan

Keywords:

AML, survival analysis

Abstract

Objective: This study evaluates survival outcomes of adult AML patients managed at a tertiary care center in Pakistan.

Methodology: This observational study included newly diagnosed AML patients ?18 years presenting to the Armed Forces Bone Marrow Transplant Centre, Rawalpindi, between January 2018 and December 2024. Patients with prior AML therapy, acute promyelocytic leukemia, or those lost to follow-up immediately after diagnosis were excluded. Diagnosis and risk stratification followed WHO 2022, FAB, and ELN 2022 criteria. Survival outcomes were analyzed using the Kaplan–Meier method.

Results: Of 229 AML patients, 180 patients were included in survival analysis. The male-to-female ratio was 1.5:1, and most patients were aged 31–50 years. Fever and weakness were common presenting symptoms while pallor being the most common clinical sign. AML with maturation was the predominant subtype, and 76.7% had intermediate risk AML as per ELN 2022. Cytogenetic abnormalities noticed in 30.6% of cases. Treatment with curative-intent was given to 149 patients, while 31 received palliative treatment. Complete remission (CR) following Intensive induction was 50.9% among non-transplant patients. Ninety-four patients underwent hematopoietic stem cell transplantation (HSCT). Common complications included febrile neutropenia (50.2%), mucositis (78.7%), and CMV reactivation (31.9%).

At a median follow-up of 727 days, overall survival was 49.1%, and disease-free survival was 37.7%. Favorable-risk AML patients had better outcomes than intermediate- and adverse-risk groups.

Conclusion: Despite recent advancements in AML therapy, significant challenges remain, particularly in resource limited settings. Diagnostic access and early treatment are essential to improve outcomes.