PROPTOSIS IN ACUTE MYELOID LEUKEMIA: AN UNDER RECOGNIZED PRESENTATION OF HEMATOLOGICAL MALIGNANCY

Abstract

OBJECTIVE: To determine the frequency of proptosis and associations of proptosis with demographic, clinical and hematological characteristics with acute myeloid leukemia (AML) in children. METHODS: This descriptive study was conducted at Combined Military Hospital, Rawalpindi, Pakistan from January 2018 to July 2020. Patients of AML between 1-12 years of age who presented with and without orbital granulocytic sarcomas (OGS), selected by non-probability convenience sampling technique were evaluated for proptosis. Patients were classified into different subtypes of AML according to French-American-British (FAB) classification. Cytogenetic studies by karyotyping were done to identify different genetic abnormalities associated with AML. Kaplan- Meier survival analysis was used to analyze the overall survival of AML patients. RESULTS: Out of 230 patients diagnosed with AML, 34 (14.78%) patients presented with proptosis. Mean age of presentation was 6.80±3.69 years, with male-female ratio of 2.1:1. Proptosis was unilateral in 19 (55%) and bilateral in 15 (45%) patients. Ten (29.40 %) patients presented primarily with proptosis while 24 (71%) patients presented with proptosis and systemic features of leukemia. Overall AML-M2 was found in 102 (44.3%) cases and other types were observed in 128 (55.6%) cases. Most common FAB AML subtype associated with proptosis was AML-M2 (n=26; 76%). Median duration of survival in AML patients with OGS was 867 days and as compared to 353 days in AML patients without OGS. CONCLUSION: Proptosis is a frequent finding in children with AML. AML-M2 is associated with proptosis in children with AML. Survival in patients with OGS was better than patients without OGS.

Keywords

• leukemia
• myeloid
• acute
• orbital
• systemic
• survival
• proptosis
• acute myeloid leukemia