Survival of pediatric acute myeloid leukemia (AML) in low- and middle-income countries (LMICs) is poor. Moi Teaching and Referral Hospital (MTRH) in Eldoret is the only academic hospital in Western Kenya treating childhood cancer. Aim: To evaluate recent outcome of pediatric AML patients at MTRH.
Medical records of 71 children (0-18 years) diagnosed between January 2010 and December 2018 with de novo AML were studied using the childhood cancer registry at MTRH, available since 2010. AML diagnosis was mainly based on morphology, cytogenetic studies were unavailable. Treatment comprised two induction courses (7+3; cytarabine, doxorubicin), two consolidation courses (5+3; cytarabine, etoposide), and triple intrathecal therapy at each course (methotrexate, hydrocortisone, cytarabine). Stem cell transplantation was unavailable. Baseline characteristics were studied and Kaplan-Meier methods were used to estimate probabilities of event-free survival (pEFS) and overall survival (pOS).
Forty-one patients were male (57.7%). Median age at diagnosis was 8.7 years (1.2-15). Four patients died before onset of treatment. Twelve patients only received palliative care. Twenty-four of the 55 patients who started treatment died before day 42 (43.6%). Five patients abandoned treatment before day 42. Early death (ED) rate was 63.4%, including the latter five abandoned patients and sixteen patients who did not start chemotherapy. Seventeen patients achieved complete remission (CR) (30.9%) of whom seven relapsed (41.2%). Treatment-related mortality (TRM) occurred in three patients. Abandonment rate was 25.4% (n=18). Seven patients are assumed to be in continuous CR with a median follow-up duration of 6.1 months (0.3-46.9), but six of them are lost to follow-up. Two-year pEFS and pOS were 5% ±3.1% and 11.3% ±5.1%, respectively.
Survival of pediatric AML in Western Kenya is poor, due to high ED, TRM and relapse rates. Priority in improving survival should be improvement of supportive care. Furthermore, reasons of abandonment should be studied to lower the rate.