PRISE EN CHARGE DES LEUCEMIES AIGUES DE L’ADULTE VUES AU CHU JOSEPH RAVOAHANGY ANDRIANAVALONA ANTANANARIVO MADAGASCAR “TREATMENT OF ADULTS ACUTE LEUKEMIA VIEWS AT THE UNIVERSITY HOSPITAL CENTER JOSEPH RAVOAHANGY ANDRIANAVALONA (CHUJRA) ANTANANARIVO”
Introduction: Acute leukemia is a rare but serious disease affecting both children and adults. It represents 15% of malignant hemopathies in Madagascar. Its evolution is quickly fatal in the absence of fast and specific care. The objective of our study is to describe the diagnostic and therapeutic management of adult acute leukemias in Madagascar in order to improve the prognosis.
Method: It wasa retrospective, descriptive study performed in the Oncology Department of CHUJRA for 5 years (January 2013 to December 2017). Patients over 15 years old with acute leukemia were included.
Results: Of the 47 cases collected, 37 were selected including 8 cases of ALL and 29 cases of AML, with a male predominance (sex ratio 2.26), an average age of 30.5 years mainly affecting the age group included between 30 and 39 years old. The main clinical signs were the signs of anemia (92%), followed by the infectious syndrome (59%), the haemorrhagic syndrome (49%), the extra-haematological locations (49%) and the tumor syndrome (30%). The hemogram confirmed signs of bone marrow failure with anemia in 89%, leukocytosis in 59%, leukopenia in 19%, neutropenia in 41% and thrombocytopenia in 92%. At the cytological level, MAHs predominated (78% with 34% M1 subtype) compared to ALL (22% with 87% L2 subtype). The treatment was exclusively symptomatic in 70% of the cases, and 30% of the patients benefited from chemotherapy, palliative for the majority. Survival time ranged from 20 to 154 days for chemotherapy patients versus 5 to 90 days for the rest. However, a significant proportion of discharges against medical advice (49%), lost to follow-up (8%) limited the evaluation of the evolution of the disease.
Conclusion: Faced with a real difficulty in the management of acute leukemias in Madagascar, improving the prognosis requires an improvement of the technical plateau.