Improving diagnosis and treatment of acute childhood leukemia in Uganda: impact of flow cytometry

Abstract

BackgroundAcute leukemia is the most common childhood cancer worldwide. Over the last few decades, survival rates have improved dramatically, with current 5-year overall survival rates for acute lymphoblastic leukemia (ALL) in high-income countries estimated at .90%. 1 This improvement in survival is mainly the result of using risk-adapted therapy and providing better supportive care.In contrast, in low-income countries, outcomes of acute leukemia remain poor because of lack of or inaccurate diagnosis, treatment-related mortality, treatment abandonment, and suboptimal treatment protocols. 2,3 Optimal outcomes require the ability to obtain rapid and accurate diagnosis and having biological data available so that modern risk-adapted protocols can be chosen. Historically, in Uganda, pediatric leukemia diagnoses were based on slides stained with hematoxylin and eosin, and the diagnosis was dependent on the availability of a hematopathologist. 3.Howard SC, Pedrosa M, Lins M, et al. Establishment of a pediatric oncology program and outcomes of childhood acute lymphoblastic leukemia in a resource-poor area.

Five decades of low intensity and low survival: adapting intensified regimens to cure pediatric Burkitt lymphoma in Africa

“…Flow cytometry is particularly advantageous because it can use tumor samples obtained by fine needle aspiration and precludes the need for general anesthesia, enables concurrent diagnoses of other hematological malignancies, is timelier than immunohistochemistry, and can be built on existing HIV immunology research infrastructure that is now widely available in many countries in SSA. 17,22,23,[74][75][76][77][78][79] The current standard for treating pediatric BL in HICs requires an accurate diagnosis to distinguish NHL arising from germinal center B cells (ie, BL and DLBCL), which are treated the same, vs other NHLs, such as those arising from T cells or precursor B cells, which require a different therapeutic strategy. In addition to morphological features consistent with lymphoid malignant proliferation, accurate diagnosis of BL requires immunophenotyping to demonstrate B-cell lineage of the malignant cells (eg, CD20, CD10) and to demonstrate the maturity of the malignant clone (eg, terminal deoxynucleotidyl transferase-negative and k or l surface immunoglobulin restriction).…”

Rapid gene fusion testing using the NanoString nCounter platform to improve pediatric leukemia diagnoses in Sub-Saharan Africa

“…Leukemia is the most common pediatric cancer, accounting for approximately 30% of all cases globally ( 2 ), and a similar rate has been observed at the Global HOPE-affiliated sites in Africa. Immunophenotyping is a critical diagnostic method for hematologic cancers in Western settings, and Global HOPE is working to ensure flow cytometry is incorporated at all its affiliated sites in SSA ( 8 ). The current approach to leukemia diagnosis in SSA includes morphology review and immunophenotype by flow cytometry (if available).…”