Cost and outcome of treatment of adults with acute myeloid leukemia at the national Cancer Institute-Egypt

Despite important advances in the therapy of acute myeloid leukemia [AML], the majority of patients die of their disease, unless bone marrow transplantation [BMT] is done. Infection and hemorrhage are still the major causes of mortality in AML patients. Progress in therapy and supportive care has led to gradual improvement in the overall results, but further improvements are still needed. The aim of this study is to identify the outcome and costs of adult AML patients treated with conventional chemotherapy [CCT] at the National Cancer Institute [NCI], Cairo University during the time period from April 1999 to January 2002. Clinical, laboratory characteristics were all recorded. Data regarding different types of therapies given for these patients including response, outcome and costs were also collected. The median age of 82 identified AML patients was 34 years. The complete remission [CR] rate after induction with CCT was 52% [42/82 patients] with a median CR duration of 9 months. Twenty-eight percent of patients who achieved CR subsequentl relapsed. By January 2003, fifty-eight patients were dead [70.7%]. Infections were the major mortality cause, followed by disease progression then bleeding [65%, 28% and 7% respectively]. The median treatment cost per patient was 33158 Egyptian Pounds [LE]. It was higher for patients who achieved CR compared to those who relapsed and/or died. Drugs contributed by 78% to the total treatment cost, while hospitalization, investigations and blood-component therapy contributed by 6%, 7% and 8% respectively. Outcome of patients with AML treated at NCI- Cairo University can be enhanced by improvement of supportive therapy; mainly infection control and expanding BMT programs to accommodate all eligible patients

prognostic index [BPI] for bilharzial related invasive bladder cancer

This study was done on 180 patients with histopathologically proven invasive bladder cancer associated with bilharziasis. They were subjected to radical cystectomy or anterior pelvic excentration. After surgery, the patients were regularly followed up for a minimum of two years. Squamous cell carcinoma was the commonest type and most of the tumors were grade II. One hundred and seventy-three patients had their tumors operable, while seven patients were inoperable. Five operative related mortalities were recorded. Free and overall survival rates of the whole group of the patients were 31.44 + 5.9% and 32.5 + 6.8%, respectively. Tumor pathologic stage, grade and nodal affection were the only significant factors that affected the survival. These three prognostic indices were used to design a model to predict an individual patientgyptians risk factor for recurrence. Then, the patients were assigned to one of four risk groups according to the score achieved in this prognostic index [0 = low risk, 1 = intermediate risk and 2 or 3 = higher risk]. These four risk groups had distinctly different rates of disease free survival, being 91.7%, 53%, 13% and 7% for low risk, intermediate risk and higher risk groups, respectively