Influence des facteurs pronostiques sur la réponse après une chimiothérapie d’induction dans les leucémies aiguës myéloïdes de novo chez les sujets jeunes en dehors des leucémies aiguës promyélocytaires.

Abstract

A prognosis factor of induction chemotherapy response in young adult’s acute myeloid leukemia de novo, outside acute promyelocytic leukemia. Introduction : They Acutes myeloids leukemias (AML) are heterogeneous maligns neoplasms on clinical, biological, cytogenetic, molecular presentation and response to treatment. The 3 + 7 regime (3 days of Anthracycline and 7 days of Aracytine) is the standard treatment for AML in young adults, complete remission (RC) is achieved in 60% and 80% cases. The aim of this study is to identify the factors influencing the response to (3 + 7) induction cure in the young adults AML de novo. Patients and methods : This is a prospective cohort study (01/06/2012 to 31/12/2015) multicenter (EHU of Oran, CHU of Oran and CHU of Tlemcen). AML de novo patients aged between 15 and 60 years were included. AML3 was excluded from the study. Results : 106 have been exploited in this work. CR was obtained in 53.8% (57) patients. , There were more CRs in the age groups [(15-20 years), CR : 8 (72.7%), p : 0.07], [(21-30 years), CR : 17 (60.7%), p : 0.08] and [(31-40 years), CR : 8 (66.7%), p : 0.08] compared with patients ages between 51 and 60 years, without statistically significant. The AML0 negatively balanced the response to the induction treatment (OR : 1.84, 95% CI : 1.23-2.58, p : 0.05). 14.1% (15) patients died during treatment ; in 46.7% of the cases (7 patients) the deaths were due to the toxicity of the treatment, and in 53.3% of the cases (8 patients), the deaths were related to the disease. Infections were responsible for 73.3% (11 cases) of deaths. Age and PS did not affect the risk of death induction in our patients. A serum créatinine level> 11mg /l (OR : 3.6, 95% CI : 1.04-12.27, p : 0.042) and serum albumin low than <35 g /l (OR : 1, 11, CI : 95%: 1, 02- 1, 21, p : 0, 04) predicted the risk of death induction. Conclusion : In the absence of cytogenetic and molecular biology, AML0 is poor prognosis compared to other cytological forms. We have found a high death rate compared to the literature, and in the majority, it is secondary to infectious complications, which prompts us to introduce antibioprophylaxis and an adapted and early empirical curative treatment