Long-term outcomes following allogeneic hematopoietic stem cell transplantation in Iraqi patients with acute leukemia

BACKGROUND: Allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains the definitive curative therapeutic option for patients suffering from acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL). Despite significant refinements in transplant protocols, achieving optimal long-term survival and managing treatment-related morbidity continue to be major challenges, particularly in healthcare settings with limited resources. OBJECTIVE: The current study aimed to evaluate long-term survival rates, incidence of relapse, post-transplant complications, and the overall quality of life (QoL) among Iraqi patients with acute leukemia who underwent allo-HSCT. MATERIALS AND METHODS: A retrospective analytical cohort study was conducted at the Baghdad Hematology and Bone Marrow Transplant Center. The study population comprised 103 patients diagnosed with AML or ALL who received allo-HSCT between March and August 2024. Data collection included demographic profiles and disease characteristics. Survival analysis was performed using the Kaplan–Meier method, while Cox proportional hazards models were utilized to determine prognostic risk factors. RESULTS: The study group had a mean age of 32.3 ± 12.2 years, with a male majority (64.1%). AML and ALL cases represented 56.3% and 43.7% of the cohort, respectively. Most procedures (98%) involved HLA-matched sibling donors. Clinical remission was attained by 72.8% of patients. The recorded relapse rate was 6.8%, while the mortality rate stood at 20.4%. Statistical analysis revealed no significant differences in survival outcomes between the AML and ALL groups. The mean survival time was 50.9 months for the ALL subgroup and 41.3 months for the AML subgroup. Dominant posttransplant complications included hepatic enzyme elevations (40%), dyslipidemia (22.3%), psychiatric symptoms (35.9%), and graft-versus-host disease (GVHD) (23.3%). CONCLUSION: Allo-HSCT demonstrates favorable long-term outcomes for Iraqi patients with acute leukemia. However, the prevalence of GVHD and psychological comorbidities significantly affects the QoL, highlighting the necessity for integrated, comprehensive long-term follow-up care.