الفهرس 
Introduction
ClassificationOnly 14 pages are availabe for public view
 |  | from | 159 |  |  |
| | | from | 159 | | |
Abstract
Summary
This study has been proposed to identify the pattern of Hematological Malignancies in our Clinical Hematolgy of Internal Medicine Department and Oncology Institute of Assiut in the period between the 1st of January 2014 and the 1st of June 2017 aiming at :
1- Evaluation of distribution of hematological malignancies and calculation the percentage of each type at assiut university hospital in the period between the 1st of January 2014 and the 1st of June 2017
2- Determination of sociodemographic charachteristics and risk factors of each type of hematological malignancies .
3- To study the pattern of Haematological Malignancies aimed to better diagnosis,monitoring and treatment of different diseases .
4- To identify disease incidence so plans can be formulated to improve the overall health of the nation.
5- Statics developed from data gathered in that manner may document the need gor health programs.
The results of this study revealed that the total number of patients were admitted to Clinical Haematology unit and Oncolgy Institute of Assiut in the period between the 1st of January 2014 and the 1st of June 2017 were calculated to be 1327 patients with different types of hematological malignancies. Mean (SD) age of the studied patients was 47.70 ± 17.51 years and the range was from 20 to 90 years. 712 (53.7%) patients were males, 615 (46.4%) patients were females and 864 (65.1%) patients were from rural areas while the other 463 (34.9%) patients were from urban area.
Regarding occupation our study showed that a total of 340 (25.5%) patients were handicraft and 220 (16.6%) patients had no job. During this study, hematological malignancies were diagnosed in 42 (3.2%) patients in different stages of education. 276 (20.8%), 244 (18.4%) and 176 (13.3%) patients were housewife, farmers, and employee respectively. 29 (2.2%) patients were on retirement.
According to the year of diagnosis, it was noticed that incidence of hematological malignancies were increasing from 2014 to 2017. The frequency of hematological malignancies was 305 (23%), 307 (23.1%), 298 (22.5%), and 417 (31.4%) patients during 2014, 2015, 2016 and 2017 respectively. During years of 2014, 2015 and 2016; incidence of hematological malignancies ranged between 22.5% and 23.1% and the incidence in 2017 was 31.4%.
Final diagnosis of the studied patients :
Totally in the current study; it was noticed that leukemia (69.1%) followed by lymphoma (10.3%) were the most frequent malignancy in our study followed by other types; myelofibrosis (7.7%), MM (7.3%) and MDS (5.6%) respectively.Leukemia was the most common encountered hematological disorder in our patients as 916 patients (69.1) of the total admitted cases were diagnosed as leukemia.
• Acute Myeloid Leukemia460 patients (34.7%).
• Acute Lymphoblastic Leukemia135 patients (10.2%).
• Chronic Myeloid Leukemia 188 patients (14.2%).
• Chronic Lymphocytic Leukemia 133 patients(10%).
• Non Hodgkin Lymhoma 110 patients (8.3%).
• Hodgkin Lymphoma 27 patients(2%).
• Primary Myelofibrosis56 patients(4.2%).
• Polycythemia Rubra Vera 43patients (3.2%).
• Essential thrombocytosis 4 patients (0.3%).
• Multiple Myeloma 97 patients (7.3%)
• Myelodysplastic syndrome 74 patients (5.6%).
Regarding relationship between cude and adjusted age incidence rate of hematological malignancies at Assiut governorate and gender and residence in each age group it was notices that :
1- Leukemia:
Crude and adjusted age incidence rate (IR) showed that males had higher IR of all types of leukemia in age groups 20- 40 and > 60 years while female had higher IR in age group 40- 60 years with exception of CLL where males had higher IR in age groups 40- 60 and > 60 years while female had higher IR of CLL in age group of 20- 40.
Males and females patients of rural areas had higher IR of all types of leukemia at different age groups with exception of ALL at age above 60 years that was equal in males in rural and urban areas.
The maximum urban – rural incidence rate difference was observed for rural incidence of CML in the age > 60 years (IRR= 0.94; 95% CI= 0.34- 1.11).
Male sex was predominant in case of AML and ALL in urban and rural areas in age groups 20- 40 and > 60 years while the other group showed female predominance. In case of CML female sex was predominant in rural while in urban areas female sex was predominant in age group 40- 60 years.It was noticed that males in rural areas had higher frequencies of CLL than females while in urban areas male predominance occurred only after age of 40.
2- Lymphoma
Crude and adjusted age incidence rate (IR) showed that females had higher IR of both types of lymphoma in age groups 20- 40 and 40- 60 years while in age group >60 years males patients had higher IRR of lymphoma. Both males and females had equal incidence rate of NHL in age group 40- 60 years.Majority of cases with Hodgkin lymphoma came from urban areas. It was noticed that rural areas had higher IR for both sexes than urban areas.
In case of the only one patient from the rural with HL was female while in case of urban areas there was male predominance above the age of 60 years while female was predominant below this age.In case of NHL; males had higher incidence rate in urban areas than female in age group 20- 40 and above 60 years but female sex was predominant at the other age groups while in rural areas the contrast presented.
3- Primary myelofibrosis
Crude and adjusted age incidence rate (IR) showed that males had higher IR of primary fibrosis at age groups 20- 40 and > 60 years while female had higher IR at the other age groups.Rural areas had higher incidence rate of primary myelofibrosis for both sexes than urban area. The maximum urban- rural difference was observed for rural areas at age group 40- 60 years (IRR= 0.6; 95% CI= 1.23- 5.98).
Male sex was predominant in both urban and rural areas with exception at age group 40- 60 years in rural areas where there was female predominant.
4- Polycythemia rubra vera
Crude and adjusted age incidence rate (IR) showed that males had higher IR of PRV in different age groups than females. Both sexes in rural areas had higher IR in different age groups than urban areas. Male sex was predominant in both urban and rural areas with exception at age group 40- 60 years in rural areas where there was female predominant.
The maximum urban- rural difference was observed for urban areas at age group 40- 60 years (IRR= 0.88; 95% CI= 2.02- 3.02).
5- Essential thrombocytosis
All patients with essential thrombocytosis were males from rural areas.
6- Myelodysplastic syndrome
Crude and adjusted age incidence rate (IR) showed that males had higher IR of MDS in different age groups than females except age group 40- 60 years where female sex was predominant.Also, male sex was predominant in both rural and urban areas. Rural areas had higher IR of MDS in different age groups with exception in age group > 60 years where females from urban areas were predominant with maximum urban- rural incidence rate was observed at this age group (IRR= 6.26; 95% CI= 0.93- 1.23).
7- Multiple Myeloma
Crude and adjusted age incidence rate (IR) showed that males had higher IR of MDS in different age groups than females except age group 40- 60 years where female sex was predominant.In the rural areas there was female predominance while male predominance was noticed in urban areas with maximum urban- rural incidence rate was observed at age group > 60 years (IRR= 2.66; 95% CI= 0.55- 1.67).
Regarding possible risk factors for Haematological Malignancies included in the current study it was noticed that DM, HTN, cigarette smoking and family history had no significant difference between different types of hematological malignancies in our study, exposure to electromagnetic field was significantly frequent in those patients with CML, patients with NHL had significantly higher frequency of HCV infection, and finally patients with AML had higher frequency of autoimmune disease, previous exposure to cancer therapy, previous exposure to radiation, obesity and exposure to chemical substances.