TY - JOUR
T1 - Treatment outcomes of pediatric acute myeloid leukemia in Western Kenya before and after the implementation of the SIOP PODC treatment guideline
AU - van Weelderen, Romy E.
AU - Wijnen, Noa E.
AU - Njuguna, Festus
AU - Klein, Kim
AU - Vik, Terry A.
AU - Olbara, Gilbert
AU - Kaspers, Gertjan J. L.
N1 - Funding Information: We want to thank Sandra Langat and Martha Kipng'etich for managing the hospital's pediatric cancer registry, and Caroline Tanui for performing the follow-up phone calls to the patients' parents/caregivers. Additionally, we thank all the medical staff of the pediatric oncology ward and the record office at MTRH for their dedication and efforts. Finally, we would like to thank all patients and their parents/caregivers for their trust in the medical team of the MTRH. The MTRH pediatric oncology unit has a collaboration with Riley Hospital for Children and Indiana University in the United States of America and the Princess Máxima Center for Pediatric Oncology in the Netherlands. Publisher Copyright: © 2023 The Authors. Cancer Reports published by Wiley Periodicals LLC.
PY - 2023/8
Y1 - 2023/8
N2 - Purpose: The Pediatric Oncology in Developing Countries (PODC) committee of the International Society of Pediatric Oncology (SIOP) published a pediatric acute myeloid leukemia (AML)-specific adapted treatment guideline for low- and middle-income countries. We evaluated the outcomes of children with AML at a large Kenyan academic hospital before (period 1) and after (period 2) implementing this guideline. Patients and Methods: Records of children (≤17 years) newly diagnosed with AML between 2010 and 2021 were retrospectively studied. In period 1, induction therapy comprised two courses with doxorubicin and cytarabine, and consolidation comprised two courses with etoposide and cytarabine. In period 2, a prephase with intravenous low-dose etoposide was administered prior to induction therapy, induction course I was intensified, and consolidation was adapted to two high-dose cytarabine courses. Probabilities of event-free survival (pEFS) and overall survival (pOS) were estimated using the Kaplan–Meier method. Results: One-hundred twenty-two children with AML were included – 83 in period 1 and 39 in period 2. Overall, 95 patients received chemotherapy. The abandonment rate was 19% (16/83) in period 1 and 3% (1/39) in period 2. The early death, treatment-related mortality, complete remission, and relapse rates in periods 1 and 2 were 46% (29/63) versus 44% (14/32), 36% (12/33) versus 47% (8/17), 33% (21/63) versus 38% (12/32), and 57% (12/21) versus 17% (2/12), respectively. The 2-year pEFS and pOS in periods 1 and 2 were 5% versus 15% (p =.53), and 8% versus 16% (p =.93), respectively. Conclusion: The implementation of the SIOP PODC guideline did not result in improved outcomes of Kenyan children with AML. Survival of these children remains dismal, mainly attributable to early mortality.
AB - Purpose: The Pediatric Oncology in Developing Countries (PODC) committee of the International Society of Pediatric Oncology (SIOP) published a pediatric acute myeloid leukemia (AML)-specific adapted treatment guideline for low- and middle-income countries. We evaluated the outcomes of children with AML at a large Kenyan academic hospital before (period 1) and after (period 2) implementing this guideline. Patients and Methods: Records of children (≤17 years) newly diagnosed with AML between 2010 and 2021 were retrospectively studied. In period 1, induction therapy comprised two courses with doxorubicin and cytarabine, and consolidation comprised two courses with etoposide and cytarabine. In period 2, a prephase with intravenous low-dose etoposide was administered prior to induction therapy, induction course I was intensified, and consolidation was adapted to two high-dose cytarabine courses. Probabilities of event-free survival (pEFS) and overall survival (pOS) were estimated using the Kaplan–Meier method. Results: One-hundred twenty-two children with AML were included – 83 in period 1 and 39 in period 2. Overall, 95 patients received chemotherapy. The abandonment rate was 19% (16/83) in period 1 and 3% (1/39) in period 2. The early death, treatment-related mortality, complete remission, and relapse rates in periods 1 and 2 were 46% (29/63) versus 44% (14/32), 36% (12/33) versus 47% (8/17), 33% (21/63) versus 38% (12/32), and 57% (12/21) versus 17% (2/12), respectively. The 2-year pEFS and pOS in periods 1 and 2 were 5% versus 15% (p =.53), and 8% versus 16% (p =.93), respectively. Conclusion: The implementation of the SIOP PODC guideline did not result in improved outcomes of Kenyan children with AML. Survival of these children remains dismal, mainly attributable to early mortality.
KW - Kenya
KW - low- and middle-income countries
KW - pediatric acute myeloid leukemia
KW - sub-Saharan Africa
KW - survival
UR - http://www.scopus.com/inward/record.url?scp=85162622567&partnerID=8YFLogxK
U2 - https://doi.org/10.1002/cnr2.1849
DO - https://doi.org/10.1002/cnr2.1849
M3 - Article
C2 - 37349659
SN - 2573-8348
VL - 6
JO - Cancer reports (Hoboken, N.J.)
JF - Cancer reports (Hoboken, N.J.)
IS - 8
M1 - e1849
ER -