The low incidence of vincristine-induced peripheral neuropathy (VIPN) in Kenyan children may result from low vincristine exposure. We performed a pharmacokinetically (PK) guided dose-escalation feasibility study of vincristine in Kenyan children (NCT05844670). Vincristine PK exposure was assessed with a previously developed nomogram. A 20% dose increase was recommended for participants with low exposure and no VIPN, hyperbilirubinemia or malnutrition. None of the fifteen participants developed VIPN. Low vincristine exposure was seen in only one participant: a dose increase was implemented without side-effects. Average vincristine exposure was high. In conclusion, the participants did not develop VIPN despite having high vincristine exposure.

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.

Background Paediatric oncology outreach programs have been effective development interventions to reduce inequalities in healthcare between high-income countries (HIC) versus low and middle-income countries (LMIC). But little is known about its sustainability during times of a pandemic. This study assesses the impact of COVID-19 government measures on a paediatric oncology outreach program between three large referral hospitals in the Netherlands, Indonesia and Kenya. Methods The head from each paediatric oncology outreach partner site was interviewed using a semi-structured questionnaire in June 2021. Results COVID-19 government measures impacted childhood cancer care at all three hospitals. However, disruptions in services are more prominent at partner sites in LMIC, increasing existing inequalities.The doctor from Dutch hospital, located in a HIC, reported only one disruption which is a decrease in surveillance evaluations for patients who completed cancer treatment. The doctors from Indonesian and Kenyan hospitals, located in LMIC, reported multiple disruptions. For example, reduced number of cancer diagnoses, delayed presentations, medical staff shortages, limited availability of chemotherapy and blood products, and delayed or modified treatment administration. Physical interaction between medical teams of all three participating institutions has slowed down. Hereby, adequate transfer of knowledge, skills and expertise have been adversely affected. Conclusion COVID-19 government measures have negatively impacted the intrinsic nature of the paediatric oncology outreach program. Disruptions in childhood cancer care services are more prominent at partner sites in LMIC. Government leaders and policy makers should take collateral damage of their policies and local settings into account to protect children with cancer