Overview of Iraqi experience in management of acute promyelocytic leukemia

Waseem Al-Tameemi; Zahra’a S. Shakir

The Medical Journal of Basrah University, 2021, Volume 39, Issue 1, Pages 21-30
DOI: 10.33762/mjbu.2021.129847.1068

Background & Objectives
In Iraq, leukemia is the 4th most common cancer, Acute promyelocytic leukemia contributes to 2.83%, and 3.18% of leukemia in Iraqi males and females respectively. This study is to review of acute promyelocytic leukemia patients presentation and management outcome in Iraq
Patients and Method
A hospital based case series study was conducted over a period of 15 months in different hematology centers. A total of 58 acute promyelocytic leukemia patients were enrolled in this study (53 newly diagnosed and 5 relapsed cases). Diagnosis based on of morphology with or without cytogenetic study.
The mean age was 33.1±13.8 years, with slight female predominance. Most cases presented at winter season (39.7%). Sanz severity scoring classification as; (25.9%) low risk, (53.4%) intermediate risk, and (20.6%) high risk disease. Induction protocol consist of chemotherapy plus ATRA in (58%) while (36.2%) received only ATRA plus ATO. At the end of induction, 86.2% of patients have complete remission, while only 13.8% have failure of induction due to death. Induction mortality was higher in those who have received chemotherapy based regimens. At relapse, a second complete remission has been achieved in 4 out of 5 cases (80%).

There is a predilection of acute promyelocytic leukemia to young age group and winter season presentation. The choice of non-chemotherapy regimens, especially for the low and intermediate risk group, showed no drawback in complete remission rate. Disease outcome in Iraq has improved over several years due to increasing experience with using different regimen