INTRODUCTION
Acute lymphoblastic leukemia (ALL) is globally the most common childhood malignancy. 1 Survival of childhood ALL has improved significantly in high-income countries (HIC) with over 90% 5-year overall survival (OS), while low-middle-income countries (LMIC) continue to register dismal survival rates.2-6 In sub-Saharan Africa, 2-year event-free survival estimates of 22% and 33% have been reported in Rwanda and Tanzania, respectively.7-8 The poor outcomes of childhood ALL in LMICs are characterized by high induction mortality, treatment abandonment, and leukemia relapse.3,6,7 These poor outcomes are associated with low socioeconomic status, delayed diagnosis and treatment, and inadequate medical resources to support the patients.4-6
Since 2010, in collaboration with twining partners from Princess Máxima Center for Pediatric Oncology in the Netherlands and Indiana University in the United States of America (USA), we have been treating children with ALL using resource-adapted protocols. The previously published treatment outcome of children with ALL in our setting between 2010 to 2016 showed low event-free survival associated with high induction mortality and abandonment rates.9 Following this observation, our team came up with strategies to reduce induction deaths and abandonment.
In this study, we compared childhood ALL outcomes before (2010-2016) and after the (2017-2020) modification of induction therapy with improved social and financial support and supportive care.