Acute myeloid leukaemia in the Johannesburg public sector: A laboratory-based study

Abstract

Background: Acute myeloid leukaemia (AML) is a haematological malignancy stratified into low, intermediate and high-risk groups according to the genetic abnormalities present at diagnosis. Data relating to the epidemiology and outcomes of AML in Africa is sparse.

Aim: This study aimed to assess the AML risk profile, selected clinico-pathological features and follow-up of AML in Johannesburg.

Setting: The Johannesburg state sector.

Methods: All new cases of AML diagnosed on flow cytometry at the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) over 42 months between 2016 and 2019 were retrospectively identified. Clinical and laboratory data were obtained from the laboratory information system.

Results: A total of 277 AMLs were identified, with a median age of 37.5 years. Conclusive risk-stratification was possible in 183 patients, with the low-risk group predominating (51.9%). The distribution of high, intermediate and low-risk cases was similar between the adults < 60 years of age and the children < 15 years, while high-risk disease was significantly more common among older adults. High-risk disease was associated with lower long-term survival rates in younger adults and children, while outcomes appeared universally poor in older adults (irrespective of risk status). Early drop-off was common in low-risk disease, with an unexpectedly high rate of relapse in some low-risk entities.

Conclusion: Low-risk AML predominates in the Johannesburg state sector, but outcomes appear guarded. Exploration of measures to reduce sepsis-related mortality and further study of differences in local disease biology are required.

Contribution: This study contributes to the limited body of knowledge of AML in South Africa.