Survival and predictors of mortality among acute leukemia patients on follow-up in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia: A 5-year retrospective cohort study

Abstract

Background: Although Ethiopia has more than 78% of leukemia cases and a significant burden of the disease, the survival of leukemia patients in the country is poorly recognized. The purpose of this study was to assess the survival and predictors of acute leukemia patients. Methods: A 5-year retrospective cohort study was conducted including all acute Leukemia patients who visited Tikur Anbessa Specialized Hospital between January 2015 and December 2019. Data were retrieved from patient's medical records between March and April 2020. Using SPSS version 25, the Kaplan–Meier curve and Cox regression models were employed to analyze the data. Results: A total of 119 patients with acute leukemia were retrospectively evaluated for 60 months, having 196 person-years of risk. About 46 deaths (38.7%) were recorded over the follow-up period, giving a mortality incidence rate of 23.5 (95% CL:18–52) per 100 person-years. The median survival time was 35 months (95% CI, 28.3–41.7). At 60 months of follow-up, the predicted overall survival rate after diagnosis for acute leukemia was 21%. The adjusted hazard ratio for acute leukemia subtypes (aHR:4.9, 95% CI:2.3–10.4), history of relapse (aHR:3.9, 95% CI:1.0–7.9), participant age (aHR:1.25, 95% CI:1–1.75), hepatomegaly (aHR:2.7, 95% CI:1.36–5.36), and splenomegaly (aHR:2.29, 95% CI:1.2–4.4). Conclusion: The 5-year overall survival rate was found to be 21%. The finding was remarkably lower than other published reports. Survival among acute leukemia patients was significantly associated with older age, history of relapse, hepatomegaly, splenomegaly, as well as certain subtypes. Therefore, improving early detection and initiation of treatment for all acute leukemia patients is necessary in order to improve patient's survival status.