Introduction: Acute leukemia (AL) represents the first hematological malignancy diagnosed and treated in Tunisia. Objective: To describe the demographic, cytological, cytogenetic and prognostic characteristics of acute myeloid leukemia (AML) in the Tunisian center over a period of 11 years. Methods: A retrospective study was performed on a series of AML cases diagnosed at Farhat Hached Hospital in Sousse, between January 2009 and December 2019. Cytological analysis according to the French-American-British classification and cytogenetic and molecular analysis allowed to classify AML according to the World Health Organization recommendations of 2016. The prognosis was established according to the recommendations of European Leukemia Net. Results: The diagnosis of AML was confirmed in 378 cases with a median age at diagnosis of 43 years and a sex ratio of 1.32. AML with maturation was observed in 31% of cases. Recurrent abnormalities were detected in 25% of karyotypes, dominated by the t(15;17) translocation. The latter was associated with 75% of promyelocytic LA. Cytogenetic abnormalities associated with myelodysplasias were detected in 17% of cases, 59% of which had a complex karyotype. AMLs without specificity accounted for 57% of AMLs. Furthermore, 55% of patients had an intermediate prognosis. Conclusion: The lack of a Tunisian registry of hematological malignancies and the increasing incidence of AML, require epidemiological studies to establish the cytological and cytogenetic profile of the tunisian population. This will allow us to reinforce the diagnostic and therapeutic means with the ultimate goal of improving the survival of patients.

1. Braham-Jmili N, Sendi-Senana H, Khelif A, Saad A. Leucémies aiguës myéloïdes en Tunisie : caractéristiques épidémiologiques et cliniques et classification OMS. JAfr Cancer, 2010; 2 :25-32.
2. Récher C, Huguet F. Leucémies aiguës myéloïdes. EMC - Traité de Médecine Akos 2022; 0(0): 1-12.
3. Miranda-Filho A, Piñeros M, Ferlay J, Soerjomataram I, Monnereau A, Bray F. Epidemiological patterns of leukaemia in 184 countries: a population-based study. The Lancet Haematol, 2018: 5(1), e14–e24.
4. Klaus M, Haferlach T, Schnittger S, Kern W, Hiddemann W, Schoch C. Cytogenetic profile in de novo acute myeloid leukemia with FAB subtypes M0, M1, and M2: a study based on 652 cases analyzed with morphology, cytogenetics, and fluorescence in situ hybridization. Cancer Genet Cytogenet. 2004; 155(1): 47-56.
5. ArberDA, Orazi A, Hasserjian R, Thiele J, Borowitz MJ, Le Beau MM, et al. The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia. Blood 2016: 127(20), 2391–405.
6. Shaffer LG, Slovak ML, Campbell LJ. ISCN (2009): International System of Human Cytogenetic Nomenclature. S.Karger AG, Basel 2009.
7. Döhner H, Estey E, Grimwade D, Amadori S, Appelbaum FR, Büchner T, et al. Diagnosis and management of AML in adults: 2017 ELN recommendations from an international expert panel. Blood. 2017, 26; 129(4): 424-47.
8. Vladimir L L, Bertil J.Why classical cytogenetics still matters in acute myeloid leukemia. Expert Rev Hematol: 2020; 13: 2, 95-97,
9. Moueleu Ngalagou PT, Ngouadjeu Dongho Tsakeu E, Ngo Sack F, Eboumbou Moukoko EC, Konn Jolly Y, Luma H et al. Epidemiology of malignant hemopathies recorded in hospitals in Cameroon. Med Santé Trop 2018; 28(1): 61-66.
10. Costello R, Venton G, Colle J, Ivanov V, Mercier C, Delassus L, et al. Leucémies aiguës myéloïdes de l’adulte. EMC - Hématologie 2018;13(4):1-12
11. Lazarevic VL, Johansson B. Why classical cytogenetics still matters in acute myeloid leukemia. Expert Rev Hematol, 2020 : 13: 2, 95-97,
12. Missaoui N, Trabelsi A, Parkin D M, Jaidene L, Chatti D, Mokni M, et al. Trends in the incidence of cancer in the Sousse region, Tunisia, 1993–2006. Int J cancer, 2010; 127(11): 2669-77.
13. Ketata N, Mejdoub Y, Maamri H, Baklouti M, Sboui I, Karray R, et al. Profil épidémio-clinique et tendances chronologiques des leucémies dans le sud Tunisien. Rev Épidémiol Santé Publique, 2022; 70, S235.
14. Haouas H, Haouas S, Hafsia A. A retrospective study of leukemia epidemiology in Northern Tunisia. Hematology, 2011; 16: 3, 151-154.
15. Defossez G, Le Guyader-Peyrou S, Uhry Z, Grosclaude P, Colonna M, Dantony E et al. Estimations nationales de l’incidence et de la mortalité par cancer en France métropolitaine entre 1990 et 2018. Synthèse. Saint-Maurice: Santé publiques France, 2019.
16. Shallis RM, Wang R, Davidoff A, Ma X, Zeidan AM. Epidemiology of acute myeloid leukemia: Recent progress and enduring challenges. Blood Rev. 2019; 36: 70-87.
17. Nafil H, Tazi I, Faez S et Benchemsi N. Profil cytologique des leucémies aiguës à Casablanca. J Afr Cancer. 2012; 4(2): 79-83.
18. Adams J, Nassiri M. Acute Promyelocytic Leukemia: A Review and Discussion of Variant Translocations. Arch Pathol Lab Med. 2015; 139(10): 1308-13.
19. Maatamri.W, Regaieg.H, Braham.A, Sendi.H, Ben Youssef.Y, Braham Jmili.N et al. Caractéristiques clinico-biologiques et thérapeutiques des leucémies aiguës promyélocytaires: à propos de 43 cas. Rev Tun Biol Clin, 2021; 28(02): 50-60
20. Tarlock, K, Meshinchi S. Pediatric acute myeloid leukemia: biology and therapeutic implications of genomic variants. Pediatr Clin North Am (2015). 62(1), 75–93.
21. Tripon F, Crauciuc GA, Bogliş A, Moldovan V, Sándor-Kéri J, Benedek IJ, et al. Co-occurrence of PML-RARA gene fusion, chromosome 8 trisomy, and FLT3 ITD mutation in a young female patient with de novo acute myeloid leukemia and early death: A CARE case report. Medicine 2020; 99(14): e19730
22. Yang JJ, Park TS, Wan TS. Recurrent Cytogenetic Abnormalities in Acute Myeloid Leukemia. Methods Mol Biol. 2017; 1541: 223-45
23. Narayanan D, Weinberg OK. How I investigate acute myeloid leukemia. Int J Lab Hematol. 2020; 42(1): 3-15.
24. Trabelsi N, Achbar M, Khalfaoui I, El Ayeb Y, Abdennebi Y B, Guermani H, et al. Apport de la Cytogénétique dans les Leucémies Aigues Myéloblastiques (LAM) de l’enfant. Morphologie, 2022: 106(354), S20.
25. Bacher U, Kern W, Schnittger S, Hiddemann W, Schoch C, Haferlach T. Further correlations of morphology according to FAB and WHO classification to cytogenetics in de novo acute myeloid leukemia: a study on 2,235 patients. Ann Hematol. 2005; 84(12): 785-91.
26. Luquet I, Bidet A, Cuccuini W, Lafage-Pochitaloff M, Mozziconacci MJ, Terré C. Place de la cytogénétique dans la prise en charge des leucémies aiguës myéloïdes: actualisation par le Groupe francophone de cytogénétique hématologique (GFCH). Ann Biol Clin. 2016 ; 74(5) : 535-46
27. Koenig KL, Sahasrabudhe KD, Sigmund AM, Bhatnagar B. AML with Myelodysplasia-Related Changes: Development, Challenges, and Treatment Advances. Genes, 2020: 11(8), 845.
28. Menssen AJ, Walter MJ. Genetics of progression from MDS to secondary leukemia. Blood. 2020;136(1):50-60.
29. Honda H, Nagamachi A, Inaba T. -7/7q- syndrome in myeloidlineage hematopoietic malignancies: attempts to understand this complex disease entity. Oncogene. 2015;34(19):2413-25.
30. Marschalek R. The reciprocal world of MLL fusions: A personal view. Biochim Biophys Acta Gene Regul Mech. 2020; 1863(7): 194547
31. Arber DA, Erba HP. Diagnosis and Treatment of Patients With Acute Myeloid Leukemia With Myelodysplasia-Related Changes (AML-MRC). Am J Clin Pathol. 2020; 154(6): 731-41.
32. Sant M, Allemani C, Tereanu C, De Angelis R, Capocaccia R, Visser O, et al. Incidence of hematologic malignancies in Europe by morphologic subtype: results of the HAEMACARE project. Blood 2010; 116(19): 3724–34.
33. Döhner K, Paschka P. Intermediate-risk acute myeloid leukemia therapy: current and future. Hematology Am Soc Hematol Educ Program. 2014;2014(1):34-43.
34. Medinger M, Passweg JR. Acute myeloid leukaemia genomics. Br J Haematol. 2017 ;179 (4): 530-42.
35. Khoury J D, Solary E, Abla O, Akkari Y, Alaggio R, Apperley J F, et al. The 5th edition of the World Health Organization Classification of Haematolymphoid Tumours: Myeloid and Histiocytic/Dendritic Neoplasms. Leukemia, (2022). 36(7), 1703–1719.