IMPROVED SURVIVAL FOR CHILDHOOD ACUTE LYMPHOBLASTIC LEUKEMIA IN A LOW
MIDDLE-INCOME COUNTRY: REDUCTION IN ABANDONMENT and relapse
Background: In our earlier published outcomes of children with
acute lymphoblastic leukemia (ALL) at Moi Teaching and Referral Hospital
in Kenya (MTRH), we showed low event-free survival (EFS) with high
induction mortality and abandonment. Based on this observation, the team
focused on strategies to reduce both causes of poor outcomes.
Intervention: We dropped doxorubicin from induction therapy as
the supply of L-asparaginase became reliable, improved social and
financial support for insurance coverage and transportation, promptly
initiated empirical antibiotics during episodes of febrile neutropenia,
and enhanced the availability of blood products. Objective: Our
study compared childhood ALL outcomes before (2010-2016) and after
(2017-2020) modification of induction therapy, with improved social and
financial support and supportive care. Methods: We reviewed the
medical records of 123 children with ALL between 2017 to 2020. Their
treatment results were collected and compared to those of 136 children
before the (2010-2016) modification of induction therapy, with improved
social and financial support. Results: Three-year EFS estimates
improved from 18.2% to 40.7%. Relapse or progressive disease decreased
from 26% to 16%, and abandonment from 24% to 14%. Deaths and
survival through induction did not change significantly between the two
periods. Children between 1-9 years and those with white blood cell
(WBC) count <50x10 9/L had better EFS.
Conclusions: Treatment abandonment and relapse decreased, and
EFS increased significantly. However, strategies to improve early
diagnosis and supportive care are needed to reduce induction mortality.
In addition, enhanced parental education and continuous counseling are
required to minimize treatment abandonment further.