Response to induction chemotherapy in children with acute lymphoblastic leukemia at Moi teaching and referral hospital, Eldoret

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.