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Abstract

Introduction. Standard positive pressure isolation room is not yet widely available in Indonesia. In several private hospitals, current best practice is admitting patients to semi-isolation room with additional protective measures. Despite the limitation, this practice is considered safe and might benefit Acute Myeloid Leukemia (AML) patients. This study aimed to analyze the leukemic profile and survival in AML patients admitted to semi-isolation room. Methods. A retrospective cohort study was conducted using secondary data from medical record of AML patients diagnosed in Mochtar Riady Comprehensive Cancer Center between 2018 – 2020. Patients were divided into semi-isolation room group and not admitted to semi-isolation room group. Semi-isolation room patients who received standard chemotherapy regimen were further analyzed according to complication, outcome, and survival.Results. We included 45 AML patients, 53.3% were females, 42.2% in the 40-59 years age group, and 28.9% were AML-M2. Fifteen patients received standard chemotherapy regimen including D3A7, FLAG, ATRA-Daunorubicin-Cytarabine in semi-isolation room, 60% of them had complete remission after treatment completion. Patients who not admitted to semi-isolation room received conservative treatments including hydroxyurea, mercaptopurine, cytarabine cytoreduction, and decitabine. Among patients in semi-isolation room, 41.2% had sepsis and 29.4 % had septic shock, with most of the sources coming from bloodstream infection (80%), Acinetobacter baumannii remained the most prevalent microorganism. Treatment outcomes showed median Progression Free Survival (PFS) of 11 months, 1-year survival was 47%, and 2-year survival was 27%.Conclusions. In countries with limited standard isolation room, treatment of AML patients in semi-isolation room with infection control protocol could be considered in order to give the standard induction chemotherapy regimen. Although there was an infection risk, strict isolation policy produced good response (60% complete remission).

References

1. Marcucci G, Bloomfeld CD. Acute myeloid leukemia. In: Longo DL, editor. Harrison’s hematology and oncology 3rd Ed. USA: Mc-Graw-Gill; 2017. p.168-80. 2. Ming Yi, Anping Li, Linghui Zhou, Qian Chu, Yongping Song, Kongming Wu. The global burden and attributable risk factor analysis of acute myeloid leukemia in 195 countries and territories from 1990 to 2017: estimates based on the global burden of disease study 2017. J Hematol Oncol. 2020;13:72.3. Shoket N, Muzamil J, Zargar TB, Wani B, Toka V, Bhat JR, et al. Clinical profile of acute myeloid leukemia in north india and utility of nontransplant measures in its management. Indian J Pediatr Oncol. 2019;40:S44-53.4. Ariza-Heredia EJ, Chemaly RF. Update on infection control practices in cancer hospitals. CA Cancer J Clin. 2018;68:340-55.5. Schlesinger A, Paul M, Gafter-Gvili A, Rubinovitch B, Leibovici L. Infection-control interventions for cancer patients after chemotherapy: a systematic review and meta-analysis. Lancet Infect Dis. 2009;9:97-107. 6. Ariza-Heredia EJ, Chemaly RF. Infection control practices in patients with hematological malignancies and multidrug-resistant organisms: special considerations and challenges. Clin Lymphoma Myeloma Leuk. 2014;14(suppl):S104-10.7. Acharya UH, Halpern AB, Wu Q, Voutsinas JM, Walter RB, Yun S, et al. Impact of region of diagnosis, ethnicity, age, and gender on survival in acute myeloid leukemia (AML). J Drug Assess. 2018;7 (1):51-3.8. Kanaan MN, Acharya UH, Cui Haiyan, Roe DJ. Do ethnicity, age, or gender independently predict overall survival in patients with acute myeloid leukemia – a SEER Review of AML diagnosis from 2004-2007. Blood. 2014;124 (21):1269.9. Shallis RM, Wang R, Davidoff A, Ma X, Zeidan AM. Epidemiology of acute myeloid leukemia: recent progress and enduring challenges. Blood Rev. 2019;36:70-87.10. Huang H-H, Chen C-M, Wang C-Y, Hsu WW-Y, Chen H-M, Ko B-S, et al. The epidemiology, treatment patterns, healthcare utilizations and costs of acute myeloid leukaemia (AML) in Taiwan. PLoS ONE. 2022;17(1):e0261871.11. Poynter JR, Richardson M, Blair CK, Roesler MA, Hirch BA, Nguyen P, et al. Obesity over the life course and risk of acute myeloid leukemia and myelodysplastic syndromes. Cancer Epidemiol. 2016;40:134-40.12. Li S, Chen L, Jin W, Ma X, Ma Y, Dong F, et al. Influence of body mass index on incidence and prognosis of acute myeloid leukemia and acute promyelocytic leukemia: a meta-analysis. Sci Rep. 2017;7:17998.13. Mazzarella L. Why does obesity promote cancer? Epidemiology, biology, and open questions. Ecancermedicalscience. 2015;9:554.14. Ahergorabi Z, Khazaei M, Moodi M, Chamani E. From obesity to cancer: a review on proposed mechanisms.Cell Biochem Funct. 2016;34:533.15. Scheller EL, Cawthorn WP, Burr AA, Horowitz MC, MacDougald OA. Marrow adipose tissue: trimming the fat.Trends Endocrinol Metab. 2016;27:392.16. Kulsoom B, Shamsi TS, Ahmed N, Hasnain SN. Clinical presentation of acute myeloid leukaemia – A decade-long institutional follow-up. J Pak Med Assoc. 2017;67(912):1837-42.17. Chang F, Shamsi TS, Waryah AM. Clinical and hematological profile of acute myeloid leukemia (AML) patients of Sindh. J Hematol Thrombo Dis. 2016;4:239. 18. Kumar M, Gaur V, Chowdhry M, Makroo RN, Sharma P. Hemoglobin level and karyotype status are independent prognostic parameters for acute myeloid leukemia: Pilot study of 244 patients. Int J Med res Health Sci. 2019;8(6):135-42.19. Zhang Q, Yang Q, Weng Y, Huang Z, Chen R, Zhu Y, et al. Neutrophil-to-lymphocyte ratio correlates with prognosis and response to chemotherapy in patients with non-M3 de novo acute myeloid leukemia. Transl Cancer Res. 2021;10(2):1013-24.20. Wang J, Zhou X, Liu Y, Li Z, Li X. Prognostic significance of neutrophil-to-lymphocyte ratio in diffuse large B-cell lymphoma: A meta-analysis. PLoS One. 2017;12:e0176008.21. Onec B, Okutan H, Albayrak M, Can ES, Aslan V, Koluman BU, et al. The predictive role of the neutrophil/lymphocyte ratio in survival with multiple myeloma: A single-center experience. J Clin Lab Anal. 2017;31:e22032.22. Stefaniuk P, Szymczyk A, Podhorecka M. The neutrophil to lymphocyte and lymphocyte to monocyte ratios as new prognostic factors in hematological malignancies – a narrative review. Cancer Manag Res. 2020;12:2961-77.23. Mushtaq MU, Chaudhary SG, Murthy GSG, Hall AC, Atallah EL, Mattison RJ. Prognostic significance of neutrophil-to-lymphocyte ratio in relapsed/refractory acute myeloid leukemia. Blood. 2018;132:5246.24. Rai S, Singh S, Gupta R. Prognostic significance of CD56 and CD7 in acute myeloid leukaemia and their outcome. Am J Blood Res. 2020;10(4):109-17.25. Gupta M, Mahapatra M, Saxena R. Cytogenetics impact on the prognosis of acute myeloid leukemia. J Lab Physicians. 2019;11(2):133-7.26. Niparuck P, Limsuwanachot N, Pukiat S, Chantrathammachart P, Rekamnuaychoke B, Magmuang S, et al. Cytogenetics and FLT3-ITD mutation predict clinical outcomes in non transplant patients with acute myeloid leukemia. Exp hematol Oncol. 2019;8:3.27. Neuendorff NR, Hemmati P, Arnold R, Ihlow J, Dörken B, Müller-Tidow C, et al. BCR-ABL+ acute myeloid leukemia: are we always dealing with a high-risk disease? Blood Adv. 2018;2(12):1409-11.28. Neuendorff NR, Burmeister T, Dörken B, Westermann J. BCR-ABL-positive acute myeloid leukemia: a new entity? Analysis of clinical and molecular features. Ann Hematol. 2016;95(8):1211-21.29. Chen Y, Hu Jianda. Nucleophosmin1 (NPM1) abdnormality in hematologic malignancies, and therapeutic targeting of mutant NPM1 in acute myeloid leukemia. Ther Adv Hematol. 2020;11:1-15.30. Jain H, Rengaraj K, Sharma V, Bonda A, Chanan R, Thorat J, et al. Infection prevalence in adolescents and adults with acute myeloid leukemia treated in an Indian tertiary care center. JCO Global Oncol. 2020;6:1684-95.31. Pandian J, Raghavan V, Manuprasad A, Shenoy PK, Nair CK. Infection at diagnosis: a unique challenge in acute myeloid leukemia treatment in developing world. Support Care Cancer. 2020;28:5449-54. 32. Murali NA, Ganesan P, Vijayakumar V, Kannan K, Radhakrishnan V, Ganesan TS, et al. Increasing incidence of multidrug-resistant gram-negative septicaemia during induction therapy of acute myeloid leukaemia. J Hosp Infect. 2016;93:314-15.

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