Acute myeloid leukaemia: challenges and real world data from India

The management of acute myeloid leukaemia (AML) in India remains a challenge. In a two-year prospective study at our centre there were 380 newly diagnosed AML (excluding acute promyelocytic leukaemia, AML-M3) patients. The median age of newly diagnosed patients was 40years (range: 1-79; 123% were15years, 163% were 60years old) and there were 244 (642%) males. The median duration of symptoms prior to first presentation at our hospital was 4weeks (range: 1-52). The median distance from home to hospital was 580km (range: 6-3200km). 109 (29%) opted for standard of care and were admitted for induction chemotherapy. Of the 271 that did not take treatment the major reason was lack of financial resources in 219 (81%). There were 27 (247%) inductions deaths and of these, 12 (445%) were due to multidrug-resistant gram-negative bacilli and 12 (445%) showed evidence of a fungal infection. The overall survival at 1year was 704%+/- 107%, 556%+/- 68% and 424%+/- 156% in patients aged 15years, 15 - 60years and 60years, respectively. In conclusion, the biggest constraint is the cost of treatment and the absence of a health security net to treat all patients with this diagnosis.