AML-145: Outcomes of Induction Therapy in Patients with Acute Myeloid Leukemia During Covid-19 Pandemic: A Retrospective Study from a Tertiary Care Cancer Centre

CONTEXT: The induction outcomes of patients with AML in India are on par with the western data. We fear that the Covid-19 pandemic, and the resultant social, financial, political, and medical disturbances, might influence outcomes. Hence, this study was conducted to establish causal relationships between Covid-19 Lockdown and induction outcomes in AML patients. OBJECTIVE: To determine the rates of induction remission, induction failure, and induction mortalities in patients with AML treated during Covid-19 pandemic and compare the results during the Lockdown period with the Lock-lifted period in India. DESIGN: This was a retrospective, observational study. Based on Covid-19 pandemic induced Lockdown period in India, patients were divided into two groups: Lockdown phase- induction therapy between 1st May and 31st August, 2020; and Lock-lifted phase- induction therapy between 1st Sept and 31st Dec, 2020. SETTING: This study was conducted in Dr. B. Borooah Cancer Institute, Guwahati, a tertiary care cancer centre, unit of Tata Memorial Centre, Mumbai, India. RESULTS: A total of 53 AML patients’ data were included in this study. Induction mortality was 45.16% in the 1st group, and 36.36% in the 2nd group (p 0.036). Partial remission rates were 40% and 29% in group 2 and 1 (p 0.086). Using survival analysis, death (event) after 2nd induction was 149.77 days (111.1-188.5) in group 1 & 137.23 (111.4-163.1) days in group 2, statistically insignificant. 2 patients died in group 1 due to Covid-19 related complications. Remission was achieved faster in Group 2, achieving complete remission in mean 94.96 days as compared to a mean 147.18 days (p 0.034) in Group 1. CONCLUSIONS: Patients with AML treated during the Covid-19 pandemic have worse outcomes than the pre-pandemic period. When compared, the patients treated during the Lock-lifted phase of Covid-19 pandemic in 2020 had better and faster response rates (partial and complete), and less induction deaths than the patients treated during the Lockdown phase. The outcomes might be explained due to concomitant Covid infections, limitations, and delay in the availability of blood products and other medications, as well as choice of induction therapies.