Outcomes of pediatric acute myeloid leukemia treatment in Western Kenya

Abstract

Background Pediatric acute myeloid leukemia (AML) is a challenging disease to treat in low‐ and middle‐income countries (LMICs). Literature suggests that survival in LMICs is poorer compared with survival in high‐income countries (HICs). Aims This study evaluates the outcomes of Kenyan children with AML and the impact of sociodemographic and clinical characteristics on outcome. Methods and Results A retrospective medical records study was performed at Moi Teaching and Referral Hospital (MTRH) in Eldoret, Kenya, between January 2010 and December 2018. Sociodemographic and clinical characteristics, and treatment outcomes were evaluated. Chemotherapy included two “3 + 7” induction courses with doxorubicin and cytarabine and two “3 + 5” consolidation courses with etoposide and cytarabine. Supportive care included antimicrobial prophylaxis with cotrimoxazole and fluconazole, and blood products, if available. Seventy‐three children with AML were included. The median duration of symptoms before admission at MTRH was 1 month. The median time from admission at MTRH to diagnosis was 6 days and to the start of AML treatment 16 days. Out of the 55 children who were started on chemotherapy, 18 (33%) achieved complete remission, of whom 10 (56%) relapsed. The abandonment rate was 22% and the early death rate was 46%. The 2‐year probabilities of event‐free survival and overall survival were 4% and 7%, respectively. None of the sociodemographic and clinical characteristics were significantly associated with outcome. Conclusion Survival of Kenyan children with AML is dismal and considerably lower compared with survival in HICs. Strategies to improve survival should be put in place including better supportive care, optimization of the treatment protocol, and reduction of the abandonment rate and time lag to diagnosis with sooner start of treatment.

Treatment outcomes of pediatric acute myeloid leukemia in Western Kenya before and after the implementation of the SIOP PODC treatment guideline

“…Diagnosis and treatment delay were defined as the time from first admission at MTRH to confirmation of diagnosis and to start of treatment, respectively. These definitions are adopted from our previous study 13 …”

“…In high‐income countries (HICs), long‐term probabilities of overall survival (pOS) of children with AML currently exceed 70% 7–10 . Considerably poorer rates have been reported in LMICs, 11 in particular in sub‐Saharan Africa 12–14 . Together with low salvage rates after relapse, high rates of treatment abandonment, early death (ED), and treatment‐related mortality (TRM) mainly explain these inferior outcomes in LMICs 11 .…”

Development of a Therapeutic Drug Monitoring Strategy for the Optimization of Vincristine Treatment in Pediatric Oncology Populations in Africa

“…A demographic dataset of 1003 Kenyan and Malawian children was used to create a virtual pediatric patient population to ensure clinical applicability. [23][24][25][26] An overview of the demographic data is presented in Supplemental Digital Content (see Table 2, http://links.lww.com/TDM/A655). The final dataset consisted of 1001 children aged between 0.2 and 17 years, with a body weight between 5 and 59 kg and a weight-for-height z-score (W-H-Z-score) between 28 and 8.3.…”

Implementation of a formalized evaluation and planning tool to improve pediatric oncology outcomes in Kenya

“…Within Kenya, financial barriers, lack of standardized treatment protocols, and inconsistent family education about the planned treatment, as well as concerns with treatment delays within the hospitals have been shown to lead to the abandonment of curative therapy. [14][15][16][17][18][19] The Pediatric Oncology Facility Integrated Local Evaluation Tool (PrOFILE) assessment was developed to identify the strengths and weaknesses of individual institutions within a country, as well as the pediatric oncology services on a national level. Following an extensive needs assessment, workshops are conducted with key stakeholders to identify actionable goals to be achieved over the next few years to improve pediatric oncology care.…”