Abstract:
Background: Pediatric acute myeloid leukemia (AML) is a challenging disease to treat
in low- and middle-income countries (LMICs). Literature suggests that survival in
LMICs is poorer compared with survival in high-income countries (HICs).
Aims: This study evaluates the outcomes of Kenyan children with AML and the
impact of sociodemographic and clinical characteristics on outcome.
Methods and Results: A retrospective medical records study was performed at Moi
Teaching and Referral Hospital (MTRH) in Eldoret, Kenya, between January 2010
and December 2018. Sociodemographic and clinical characteristics, and treatment
outcomes were evaluated. Chemotherapy included two “3 + 7” induction courses
with doxorubicin and cytarabine and two “3 + 5” consolidation courses with
etoposide and cytarabine. Supportive care included antimicrobial prophylaxis with
cotrimoxazole and fluconazole, and blood products, if available. Seventy-three children with AML were included. The median duration of symptoms before admission
at MTRH was 1 month. The median time from admission at MTRH to diagnosis was
6 days and to the start of AML treatment 16 days. Out of the 55 children who were
started on chemotherapy, 18 (33%) achieved complete remission, of whom 10 (56%)
relapsed. The abandonment rate was 22% and the early death rate was 46%. The
2-year probabilities of event-free survival and overall survival were 4% and 7%,
respectively. None of the sociodemographic and clinical characteristics were significantly associated with outcome.
Conclusion: Survival of Kenyan children with AML is dismal and considerably lower
compared with survival in HICs. Strategies to improve survival should be put in place
including better supportive care, optimization of the treatment protocol, and reduction
of the abandonment rate and time lag to diagnosis with sooner start of treatment
