Abstract:
Background: An earlier study on children diagnosed with acute lymphoblastic leukemia (ALL) at Moi Teaching and Referral
Hospital (MTRH) in Kenya reported a low event-free survival (EFS), excess treatment abandonment, and high induction mortality.
Based on these observations, our team focused on implementing strategies to reduce the causes of poor outcomes.
Intervention: The interventions were designed to reduce toxic deaths while maintaining the efficacy of treatment. The strategies
included are as follows: (1) substituting asparaginase for doxorubicin in induction; (2) enhanced supportive care, increased access
of antibiotics and blood products; (3) enhanced social and financial support for all underserved patients at the time of diagnosis.
Our study compared childhood outcomes of ALL treatment before and after implementation of these intervention strategies at
MTRH.
Methods: We retrospectively reviewed the medical charts of 123 children diagnosed with ALL between 2017 and 2020 (cohort 2).
Their clinical profiles and treatment data were collected and subsequently compared to that of 136 children diagnosed between 2010
and 2016 (cohort 1) before the implementation of the interventions above. Survival analysis was compared using the Kaplan–Meier
method.
Results: Three-year EFS estimates improved from 18% to 41% (p = 0.0001). Relapse and progressive disease decreased from 26%
to 16% (p = 0.04136), and the abandonment decreased from 24% to 14% (p = 0.03318), respectively. Deaths in induction decreased
from 24% to 17% (p = 0.198). Children between 1 and 9 years and those with white blood cell (WBC) count <50 × 109/L had better
EFS (50% vs. 26%, p < 0.001 and 50% vs. 24%, p = 0.017, respectively).
Conclusions: Use of systematically generated data and application of locally adapted interventions led to a reduction in treatment
failure and increased survival. Improved access to asparaginase by working with local suppliers and increased insurance coverage
through parental education and philanthropies are strategies that could be adopted by centers in low- and middle-income
countries. More efforts are required to improve risk stratification for newly diagnosed ALL patients.
