Acute Myeloid Leukemia: Does One Size Fit All? A Retrospective Analysis of Outcomes of Therapy at Moi Teaching and Referral Hospital in Eldoret, Kenya.

e18529 Background: Care for acute myeloid leukemia (AML) remains challenging despite advances in therapy. There is a wide gap between the standard of care in high-income countries (HIC) – and the options available in low- to middle-income countries (LMIC). Institutional experience at Moi Teaching and Referral Hospital (MTRH) has shown that patients receiving the traditional 7+3 chemotherapy typically die within the same hospital stay from treatment related adverse effects. Institutional practice has relied on low-dose cytarabine (20 mg intravenously every 12 hours for 10 days per cycle) every 4 – 6 weeks. We aimed to study the outcomes of this approach. Methods: We analyzed data for adult patients with AML treated at MTRH over a period of 36 months between June 2012 and July 2015. Medical information was extracted from a deidentified database built for quality improvement purposes. Results: 20 patients, 9 females and 11 males, with mean age at diagnosis of 43.9 ± 17.4 years were treated for AML. 17 patients (85.0%) received low-dose cytarabine with the mean number of cycles being 1.1. One patient received one cycle of doxorubicin and one other received one cycle of cytarabine and doxorubicin prior to low-dose cytarabine. The median overall survival was 181 days (range: 1 – 721 days). 11 patients (64.7%) completed at least one full cycle of cytarabine. An analysis excluding 8 patients lost to follow up showed a mean survival of 273.5 days for patients who completed at least one cycle of low-dose cytarabine therapy compared to 143.5 days for those who did not. 15 patients died of the disease within one year of diagnosis. Five-year survival remains at a striking 0% as compared to rates consistently > 50% in patients < 70 years of age in HIC. Conclusions: AML therapy results remain poor in Kenya compared to outcomes from HIC. There is need for prospective studies in LMIC aimed at optimizing care. Improvement in hospital infrastructure to minimize the risk of infections and maximize access to blood products, and establishment of hematopathology service are important steps to undertake in preparation for more cytotoxic and transplant therapies to be available.