Response to Front and Second Line Treatment in Patients with Acute Non Lymphoblastic Leukemia: A Single Center Experience

Research Article

Ann Hematol Oncol. 2020; 7(3): 1291.

Response to Front and Second Line Treatment in Patients with Acute Non Lymphoblastic Leukemia: A Single Center Experience

Elyamany A1, Khaled SA2*, Farghaly R1 and Abdallah AZ3

¹Department of Medical Oncology, South Egypt Cancer Institute, Assiut University, Egypt

²Department of Internal Medicine, Clinical Hematology Unit, Assiut University Hospital/BMT Unit, South Egypt Cancer Institute, Faculty of Medicine, Assiut University, Egypt

³Department of Clinical Oncology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt/Oncology consultant, KSMC-Riyadh-KSA

*Corresponding author: Safaa A.A. Khaled, Department of Internal Medicine, Clinical Hematology Unit, Assiut University Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt

Received: February 22, 2020; Accepted: March 16, 2020; Published: March 23, 2020


Background: Acute Non- Lymphoblastic (ANLL) is the type of leukemia with the worst prognosis. Over the past 30-years, treatment of ANLL consisted of two phases, frontline therapy aimed to achieve leukemic cell clearance, and second line to prevent relapse. This study assessed response to front and second line therapy in patients with ANLL.

Methods: Data of 90- ANLL patients were retrospectively collected from hospital records of those who were admitted at the Department of Medical Oncology, South Egypt Cancer Institute (SECI) in the period 2000-2010. Patients were treated with frontline induction regimens, and second line therapy in the form of HAM (33.9%), consolidation for M3 (6.5%). 59.7% of our patients discontinue treatment.

Results: 68.9% of patients achieved Complete Remission (CR) that was different among different induction courses. Patients who received HAM, 17 continue remission for a period from 3-18 month till BMT. Those didn’t received HAM, 11 patients suffered from relapse. The longest overall (OS) and Disease Free Survival (DFS) were 20 and 18 month in 10.6% and 1.1% respectively. Those who achieved CR after first 1st induction had longer OS and DFS, P <0.05.

Conclusion: This study concluded that early blast clearance is a good prognostic factor in ANLL. Also it encouraged post remission therapy with HAM to lengthen DFS till HSCT. However patient incompliance was a problem, accordingly efforts has to be exerted to keep patients in regular treatment.

Keywords: ANLL; Frontline therapy; Second line


ANLL is a hematopoietic myeloid stem cell disorder in which the bone marrow is flooded wih immature myeloid lineage cells that interfer with the production of normal blood cells [1]. For the past 30 years, and uptill now, treatment of ANLL has generally consisted of two phases. The first phase attempts to produce CR and named the induction phase. CR is defined as a bone marrow blasts less than 5% blasts, a neutrophil count greater than 1000, and a platelet count greater than 100 000. CR is the only response that leads to cure and, at the least, to an extension in survival. This can be achieved in about 60–80% of patients with ANLL with intensive chemotherapy regimens, but at least 30% of these patients will develop relapse thereafter. The second phase of therapy aims to prolong the CR. Once a patient has been in remission for 3 years, the likelihood of relapse declines sharply to less than 10% [2].

SECI is a tertiary health center that provides cancer care and treatment to patients with various malignanacies at Upper Egypt. A recent study in Upper Egypt found that only 16.3% only of ANLL received consolidation therapy [3]. Another study at Kasr Al Ainy center of clinical oncology and nuclear medicine in the period 2010- 2014, showed that the CR of patients with ANLL was 65%, 12.5% early deaths, 13.8% with refractory disease and the OS was 11.5 months, furthermore half of remitent patients relapsed [4].

As far as we know, this is the first study that assesed response to front and second line treatment in adult patients with ANLL at SECI and adressed clinical challenges of patient managment at this big institute.

Patients and Methods

Data of ANLL patients who were admitted and treated at SECI from 2000 to 2010 were retrospectively collected from patients’ files, then arranged and recorded on a new sheet for the study. The extracted data included patients’ demographics and ECOG (Eastern Cooperative Oncology Group) performance status. Type of ANLL either by morphology, immunophenotyping and data concerned with drugs used in induction and consolidation were also collected. Particular attention was paid to bone marrow results to document the following: Diagnosis, CR, relapse, and PFS. Unfortunately, cytogenetic and molecular profiles were unavailable for most of the patients thus were omitted. Each record was thoroughly examined to collect the date of death and have the OS. Multiple records of the same patient, who was admitted more than once, were considered as a single record to obtain a full course of the disease.

PFS is the time from the start of treatment to the first documentation of objective tumor progression. OS is the time from start of treatment to date of death as a result of any cause or last follow up.

Statistical Analysis

The collected data were verified, coded then analyzed by using the Statistical Package for Social Sciences (SPSS/PC/VER 17) also a recent version of GraphPad Prism was used. Nevertheless, some records were incomplete others included missing data, accordingly they were excluded. Descriptive statistics: mean, standard deviation, frequencies, percentage were calculated. Kaplan-Mayer and Survival analysis was calculated. Significant test results were considered when P value was < 0.05.

Ethical Considerations

The study protocol and methods were consistent with the World Medical Association Declaration of Helsinki, also were approved by the Department of Higher affairs at SECI. Moreover, the study received approval from the Ethics Committee of the Faculty of Medicine, Assiut University. However, as the study was retrospective patient consent was inappropriate. Confidentiality was assured.


Demographic and disease characteristics of the study patients

Table 1, showed demographic clinical and disease characteristics of 90 patients with ANLL at SECI from 2000– 2010. The mean age was (37.9±6.9 years), 51.1% were males. Residence ANLL patients at SECI from 2000 – 2010¸ 44 patients were from Assiut (48.9 %)¸ 19 from Sohag (21.1%)¸ 8 from Qena (8.9 %)¸ 5 from Aswan (5.6 %)¸ 4 from El-Menia (4.4%)¸ 1 patient from El-wady (1.1 %)¸ 1 patient from Red sea governorate (1.1 %), data on residence was missed in 8 patients (8.9 %). ECOG performance status was 1 in 76 patients (84.4 %) and 2 in 14 patients (15.6 %). TLC for the study patients was <100.000 in 86 patients (95.6%) and 4 patients had leukocytic count >100.000 (4.4%). Only 5 patients had CNS infiltration (5.6%).