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Outcomes of Induction Therapy in Patients With Acute Myeloid Leukemia During the COVID-19 Pandemic: A Retrospective Study From a Tertiary Cancer Center

Background: The induction outcomes of patients with acute myeloid leukemia (AML) in India are at par with western data. But we fear that the absence of a robust defense mechanism during the COVID-19 pandemic and the resultant social, financial, political, and medical disturbance might have influence...

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Autores principales: Iqbal, Asif, Daniel, Nithin Raj, Reddy, Raghavender, Hazarika, Munlima, Deka, Roopam
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9635016/
https://www.ncbi.nlm.nih.gov/pubmed/36348908
http://dx.doi.org/10.7759/cureus.29940
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author Iqbal, Asif
Daniel, Nithin Raj
Reddy, Raghavender
Hazarika, Munlima
Deka, Roopam
author_facet Iqbal, Asif
Daniel, Nithin Raj
Reddy, Raghavender
Hazarika, Munlima
Deka, Roopam
author_sort Iqbal, Asif
collection PubMed
description Background: The induction outcomes of patients with acute myeloid leukemia (AML) in India are at par with western data. But we fear that the absence of a robust defense mechanism during the COVID-19 pandemic and the resultant social, financial, political, and medical disturbance might have influenced outcomes. Hence, this study was conducted to establish relationships between the coronavirus disease 2019 (COVID-19) lockdown and induction treatment outcomes in AML patients. Objective: To determine rates of induction remission, induction failure, and induction mortalities in patients with AML treated during the COVID-19 pandemic and compare those results between lockdown and post-lockdown periods in India. Methods: This retrospective, observational study includes data from patients with AML who were started on induction therapy between May 1, 2020, and December 31, 2020. A total of 53 AML patients’ data was included in this study, divided into group 1 (n = 22) and group 2 (n = 31). Based on the COVID-19 pandemic-induced lockdown period in India, patients who were given induction therapy between May 1, 2020, and August 31, 2020, were included in Group 1 (Lockdown Phase group), and patients who were given induction therapy during the post-lockdown phase, i.e., September 1, 2020, to December 31, 2020, were included in Group 2 (Post-Lockdown Phase group). Data from AML patients of both sexes and all age groups were included. Data of patients who died before starting induction chemotherapy or patients who left the hospital before the completion of induction chemotherapy were excluded. Patients on induction therapy, be it intensive chemotherapy (ICT) or low dose chemotherapy (LCT), were included. Outcomes were analyzed after the first two induction cycles or 60 days of starting induction, whichever is earlier. Results: The mean age of patients in Group 1 was 36.23±19.1 years and in Group 2 was 29±22.22 years; gender distribution was comparable in both groups. After the first induction, mortality in Group 1 was 36.36%, and in Group 2 was 45.16% (p = 0.036); partial remission in Group 1 and Group 2 was 50% and 29%, respectively (p = 0.036). Using survival analysis, death (event) after second induction was 149.77 days (111.1-188.5) in Group 1 and 137.23 (111.4-163.1) days in Group 2, which was statistically insignificant. Remission was achieved faster in Group 2, achieving complete remission in the mean of 94.96 days (74.5-115.5), while in Group 1, the mean of 147.18 days (110.9-183.5) (p = 0.034). Conclusions: There was increased induction mortality and reduced complete remission (CR) during the post-lockdown phase despite the increased use of ICT, demonstrating an improvement in supportive care (availability of medicines, blood products). This shows that the improvement in supportive care did not show any change or improvement in the outcome for the patient. The mean days for remission were lower in the post-lockdown period compared to the lockdown phase, and patients who had achieved remission had a durable response.
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spelling pubmed-96350162022-11-07 Outcomes of Induction Therapy in Patients With Acute Myeloid Leukemia During the COVID-19 Pandemic: A Retrospective Study From a Tertiary Cancer Center Iqbal, Asif Daniel, Nithin Raj Reddy, Raghavender Hazarika, Munlima Deka, Roopam Cureus Emergency Medicine Background: The induction outcomes of patients with acute myeloid leukemia (AML) in India are at par with western data. But we fear that the absence of a robust defense mechanism during the COVID-19 pandemic and the resultant social, financial, political, and medical disturbance might have influenced outcomes. Hence, this study was conducted to establish relationships between the coronavirus disease 2019 (COVID-19) lockdown and induction treatment outcomes in AML patients. Objective: To determine rates of induction remission, induction failure, and induction mortalities in patients with AML treated during the COVID-19 pandemic and compare those results between lockdown and post-lockdown periods in India. Methods: This retrospective, observational study includes data from patients with AML who were started on induction therapy between May 1, 2020, and December 31, 2020. A total of 53 AML patients’ data was included in this study, divided into group 1 (n = 22) and group 2 (n = 31). Based on the COVID-19 pandemic-induced lockdown period in India, patients who were given induction therapy between May 1, 2020, and August 31, 2020, were included in Group 1 (Lockdown Phase group), and patients who were given induction therapy during the post-lockdown phase, i.e., September 1, 2020, to December 31, 2020, were included in Group 2 (Post-Lockdown Phase group). Data from AML patients of both sexes and all age groups were included. Data of patients who died before starting induction chemotherapy or patients who left the hospital before the completion of induction chemotherapy were excluded. Patients on induction therapy, be it intensive chemotherapy (ICT) or low dose chemotherapy (LCT), were included. Outcomes were analyzed after the first two induction cycles or 60 days of starting induction, whichever is earlier. Results: The mean age of patients in Group 1 was 36.23±19.1 years and in Group 2 was 29±22.22 years; gender distribution was comparable in both groups. After the first induction, mortality in Group 1 was 36.36%, and in Group 2 was 45.16% (p = 0.036); partial remission in Group 1 and Group 2 was 50% and 29%, respectively (p = 0.036). Using survival analysis, death (event) after second induction was 149.77 days (111.1-188.5) in Group 1 and 137.23 (111.4-163.1) days in Group 2, which was statistically insignificant. Remission was achieved faster in Group 2, achieving complete remission in the mean of 94.96 days (74.5-115.5), while in Group 1, the mean of 147.18 days (110.9-183.5) (p = 0.034). Conclusions: There was increased induction mortality and reduced complete remission (CR) during the post-lockdown phase despite the increased use of ICT, demonstrating an improvement in supportive care (availability of medicines, blood products). This shows that the improvement in supportive care did not show any change or improvement in the outcome for the patient. The mean days for remission were lower in the post-lockdown period compared to the lockdown phase, and patients who had achieved remission had a durable response. Cureus 2022-10-05 /pmc/articles/PMC9635016/ /pubmed/36348908 http://dx.doi.org/10.7759/cureus.29940 Text en Copyright © 2022, Iqbal et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Emergency Medicine
Iqbal, Asif
Daniel, Nithin Raj
Reddy, Raghavender
Hazarika, Munlima
Deka, Roopam
Outcomes of Induction Therapy in Patients With Acute Myeloid Leukemia During the COVID-19 Pandemic: A Retrospective Study From a Tertiary Cancer Center
title Outcomes of Induction Therapy in Patients With Acute Myeloid Leukemia During the COVID-19 Pandemic: A Retrospective Study From a Tertiary Cancer Center
title_full Outcomes of Induction Therapy in Patients With Acute Myeloid Leukemia During the COVID-19 Pandemic: A Retrospective Study From a Tertiary Cancer Center
title_fullStr Outcomes of Induction Therapy in Patients With Acute Myeloid Leukemia During the COVID-19 Pandemic: A Retrospective Study From a Tertiary Cancer Center
title_full_unstemmed Outcomes of Induction Therapy in Patients With Acute Myeloid Leukemia During the COVID-19 Pandemic: A Retrospective Study From a Tertiary Cancer Center
title_short Outcomes of Induction Therapy in Patients With Acute Myeloid Leukemia During the COVID-19 Pandemic: A Retrospective Study From a Tertiary Cancer Center
title_sort outcomes of induction therapy in patients with acute myeloid leukemia during the covid-19 pandemic: a retrospective study from a tertiary cancer center
topic Emergency Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9635016/
https://www.ncbi.nlm.nih.gov/pubmed/36348908
http://dx.doi.org/10.7759/cureus.29940
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