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.