N.A.OTHIENO-ABINYA, FRCPDEPARTMENT OF CLINICAL MEDICINE AND THERAPEUTICS, UNIVERSITY OF NAIROBI.

Acute leukaemias among post-paediatric patients at Kenyatta National Hospital in 2013-2014.

Background:

Acute leukaemias are characterized by abrupt onset, rapid downward progression and death within weeks if not effectively treated

. Their proper management is usually demanding, and requires a dedicated unit with excellent hygiene, effective antimicrobials, dedicated staff and a responsive blood donor service capable of delivering blood and blood products at short notice.

Objectives:

In 1991 we published a paper on the poor outcome of acute leukaemias at KNH.

Two decades later the prevailing conditions by then don’t seem to have changed significantly.

In an ongoing study on myelodysplastic syndromes and acute leukaemias among patients aged 13 years and above, we carried out an interim analysis on treatment outcomes.

Methods:

Details taken included biodata, leukaemia subtypes, treatment and outcomes.

Results:

Total of 55 patients included.

Variable/ Number /Percentage

Gender Number Percentage

Male 36 65.5

Female 19 34.5Leukaemia type AML 29 54.7 ALL 26 47.3

AGE

Condition Median age Age range AML 30 13-80

ALL 26 13-56

Note: Ages 0-12 were excluded

Outcomes

Condition CR No(%) Death No (%)

AML 1 (3.4) 7(24.1)

ALL 7 (26.9) 9 (27.3)

Note: early deaths in AML, relapses and deaths in ALL

Causes of death

Condition Number Percentage

Anaemia 9 60

Neutropenic sepsis 2 13.3Thrombocytopenic 1 6.7 haemorrhage 1 6.7

Others 4

26.7%

Median survival

Condition Median Range

AML 7 1-19ALL 8 1-29

Conclusion:

The outcome for acute leukaemia in 2013/2014 has not changed from the early 1990s. Lack of blood was commonest cause of death.

Induction deaths characterized AML while relapses and deaths were common in ALL.

Comments

Anaemia could have been prevented more easily with a responsive blood donor service.

Common causes of death in acute leukaemia such as thrombocytopenic bleeding and septic neutropenia could have emerged in the next stage if anaemia had been corrected.

All major /teaching hospitals need dedicated leukaemia services, with paid-up blood donor services to be considered.

SEPSIS

YOUR ENVIRONMENT/MY ENVIRONMENT

Acknowledgements

MD Maina A Odhiambo A Waweru J Rajab A Kalebi P Wanzala