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TREATMENT OF CHILDHOOD ACUTE LYMPHOBLASTIC LEUKEMIA IN IRAQ: A 17-YEAR EXPERIENCE FROM A SINGLE CENTER
  • +16
  • Salma Al-Hadad,
  • Mazin Al-Jadiry,
  • Hasanein Ghali,
  • Safaa Al-Badri,
  • Raghad Al-Saeed,
  • Amir Al-Darraji,
  • Ahmed Sabhan,
  • Samaher Fadhil,
  • Hanadi Hussein,
  • Wisam Abed,
  • Najiha Ameen,
  • Jawad Sarhan,
  • Ghufran Jaafar,
  • Aseel Abed,
  • Sara Mohamed,
  • Maria Luisa Moleti,
  • alfonso piciocchi,
  • robin foà,
  • Anna Maria Testi
Salma Al-Hadad
College of Medicine, University of Baghdad, Oncology Unit-Children Welfare Teaching Hospital, Medical City
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Mazin Al-Jadiry
College of Medicine, University of Baghdad, Oncology Unit-Children Welfare Teaching Hospital, Medical City
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Hasanein Ghali
College of Medicine, University of Baghdad, Oncology Unit-Children Welfare Teaching Hospital, Medical City,
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Safaa Al-Badri
College of Medicine, University of Baghdad, Oncology Unit-Children Welfare Teaching Hospital, Medical City,
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Raghad Al-Saeed
Children Welfare Teaching Hospital, Medical City
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Amir Al-Darraji
Children Welfare Teaching Hospital, Medical City
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Ahmed Sabhan
Children Welfare Teaching Hospital, Medical City
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Samaher Fadhil
Children Welfare Teaching Hospital, Medical City
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Hanadi Hussein
Children Welfare Teaching Hospital, Medical City
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Wisam Abed
Children Welfare Teaching Hospital, Medical City
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Najiha Ameen
Children Welfare Teaching Hospital, Medical City
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Jawad Sarhan
Children Welfare Teaching Hospital, Medical City
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Ghufran Jaafar
Children Welfare Teaching Hospital, Medical City
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Aseel Abed
Children Welfare Teaching Hospital, Medical City
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Sara Mohamed
University of Rome La Sapienza
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Maria Luisa Moleti
Sapienza University of Rome
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alfonso piciocchi
Ginema Foundation Onlus
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robin foà
Sapienza University of Rome
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Anna Maria Testi
Sapienza University of Rome

Corresponding Author:[email protected]

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Abstract

Background: About 300 childhood cancer cases are diagnosed annually at the Children Welfare Teaching Hospital (CWTH) in Baghdad, Iraq, and aproximately 32% are acute lymphoblastic leukemia (ALL). Procedure: We performed a retrospective single-center analysis of 1415 ALL children ranging from 1 to 15 years, diagnosed between January 2000 and December 2016. Patients were divided into three cohorts according to treatment period (2000-2005; 2006-2011; 2012-2016). Treatment protocols were based on three consecutive, modified and locally adapted pediatric UKALL protocols (-97, -2003, -2011); a 7-day steroid pre-phase was introduced for all patients from September 2008. Results: The overall complete remission (CR) rate was 86%. It progressively increased from 80% to 91% in the last study period. Early deaths occurred in 10% of children, decreasing from 12% to 6%, over time. Induction treatment abandonment rate was 3%. Relapse occurred in 23% of children. Toxic deaths and overall treatment abandonment in CR were 8% and 13%, respectively. Remission deaths remained unchanged, while abandonments decreased from 23% to 6% over time. At a median follow-up of 65.3 months, with abandonment considered as an event, the 5-year overall survival and event-free survival were 62.2% and 46.3%, and were statistically influenced by the treatment period. Conclusions: Though pediatric ALL survival in Iraq is still below that observed in high income countries, survival rates have progressively improved. Toxic deaths remain an important cause of failure. Pediatric oncologists fully dedicated to the improvement of patients’ care have significantly contributed to lower rates of early deaths, abandonment and treatment failures.