Therapeutic Aspects and Outcome of Hematological Malignancies at the Military Hospital of Antananarivo, Madagascar

Background: Currently, the prognosis of hematological malignancies continues to improve in developed countries. In developing countries, such as Madagascar, data on hematological malignancies treatment and outcome are often rare, incomplete, or nonexistent. Until 2011, there was only one cancer center in Madagascar. The Medical Oncology Unit of the Military Hospital of Antananarivo, Madagascar, managed hematological malignancies since December 2012. This pathology represents there the fourth most frequent cancer. Objectives: We aimed to describe the therapeutic aspects and outcome of hematological malignancies managed at this center. Methods: This was a longitudinal study (descriptive and analytic) carried out from December 1, 2012 to August 31, 2015 (33 months). We included all patients followed, then, excluded those without pathologic evidence, cases of monoclonal gammopathy of un- known significance, and cases of solid cancers. Results: We followed up 57 cases of hematological malignancies. The mean age was 49.4 ± 15.5 years and sex ratio (male/female) was 1.71. A total of 34 patients (60%) received specific treatment and 40% of the patients undertook only symptomatic treatment. The median follow-up time was 60 days and mean survival time was estimated at 410 ± 61 days for all patients combined. The mean survival time varied significantly according to the nosological subgroup and to the type of treatment received (P = 0.004). At the end of the study 20 patients (35.1%) died and 17 patients (29.8%) were lost to follow-up. Conclusions: Our results are globally similar to the results found in other African studies. Improving diagnosis, establishing a hematopoietic stem cell transplant center, and improving access to specific therapies should improve the prognosis of our patients.