Overview of Iraqi experience in management of acute promyelocytic leukemia

Objectives: In Iraq, leukemia is the 4 most common cancer, and acute promyelocytic leukemia contributes to 2.83% and 3.18% of leukemia in Iraqi males and females respectively. The aim of this study is to review the presentation and management outcome of patients with acute promyelocytic leukemia in Iraq. Methods: A hospital-based cross-sectional study was conducted over the period of 15 months in different hematology centers. A total of 58 patients with acute promyelocytic leukemia were enrolled in this study (53 newly diagnosed and 5 relapsed cases). Diagnosis was based on morphology with or without cytogenetic study. Results: The mean age was 33.1±13.8 years, with slight female predominance. Most cases presented at winter season (39.7%). Sanz severity scoring classification of patients as (25.9%) with low risk, (53.4%) intermediate risk, and (20.6%) high risk disease. Induction protocol consist of chemotherapy plus ATRA in (58%), while (36.2%) received only ATRA plus ATO. At the end of induction, (86.2%) of patients had complete remission, while only 13.8% had failure of induction and death. Induction mortality was higher in those who had received chemotherapy-based regimens. At relapse, a second complete remission had been achieved in 4 out of 5 cases (80%). Conclusion: There is a predilection of acute promyelocytic leukemia to young age group and winter season presentation. The choice of non-chemotherapy regimens, especially for the low and intermediate risk group, showed no drawback in complete remission rate. Disease outcome in Iraq has improved over several years due to increasing experience with using different regimen.