Abstract:
Background
Acute leukemia is a common form of cancer in children comprising approximately 30%
of all childhood malignancies in the developed countries. At The Moi Teaching and
Referral Hospital (MTRH), acute lymphoblastic leukemia (ALL) is the second most
common malignancy in the paediatric age group. Current cure rates in developed world
approach 80%, while in the developing world they are less than 35%. This study looks
at the response of paediatric ALL to induction chemotherapy which is a major factor in
determining the likelihood of achieving cure.
Objective
To determine the response of paediatric acute lymphoblastic leukemia to induction
chemotherapy at MTRH
Methodology
The Paediatric oncology unit in the paediatric ward, MTRH-Eldoret, Kenya was the
study site. This was a Prospective Study design. The study subjects were children under
the age of 14 years admitted to oncology ward who met study criteria. Demographic
data and clinical features at presentation were documented together with the initial
laboratory work-up in a data collection form. Bone Marrow Aspirate was done on 30
(100%) patients. On completion of induction, the clinical and laboratory responses
together with the outcomes in terms of survival (remission or no remission) or death
were documented. This data was stored in a password locked computer data base and
analysis was performed using STATA version 12 special edition and presented in
tables. Tests of association done by the Pearson’s Chi Square test and survival analysis
by Kaplan-Meier curves.
Results
Out of 30 patients, 20 (67%) were females and 20 (67%) were aged between 1-10years
with the median age at enrolment being 8 years (IQR: 6-11). Patients who initially
presented with anaemia were 28 (93%) and 25 (83%) of the patients presented with
fever. Majority of the patients, 16 (53%) had a white blood cell count of above
50,000/ul. Only 1 (3%) of the patients had CNS disease at presentation. At completion
of induction therapy, 23 (73%) patients went into complete remission (<5% blasts in
bone marrow), 2 (7%) went into partial remission (5–25% blast cells in bone marrow)
and 1 (3%) did not go into remission (>25% blast cells in the bone marrow). During the
course of induction therapy, 4 (13%) patients died giving a case mortality rate of 3.4
deaths per 100 person days. There was significant association between mortality and
patients aged less than 1 year (Fisher’s exact P=0.020).
Conclusion
Most patients had good prognostic factors which include female gender, age between 1-
10 years, no CNS disease at presentation and a white blood cell count less than
50,000/ul. Majority of these patients achieved complete remission. Patients below 1
year had bad outcomes. Long term studies need to be done for children with ALL for
further survival analysis. More aggressive treatment is required for those presenting
below the age of 1 year.