Clinical presentation and outcome of acute leukemias in children at uganda cancer institute.

Abstract

INTRODUCTION: Acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) are the commonest acute leukemias in children. Over the past three decades, significant progress has been made in the treatment of children and adolescents with acute leukemia in developed countries. This has lead to high cure rates in childhood acute leukemia in the developed world but not much has been done in developing countires. The socioeconomic disparities and poor health care systems could be responsible for this difference. Little is known about the presenting features and factors affecting outcome in black African children with acute leukemiias. Description of the clinical presentation in our children is needed in order to determine our patterns and factors associated with outcome. OBJECTIVE: To describe the presentation and outcome of acute leukemia in children admitted at Uganda Cancer Institute. STUDY DESIGN: This was a retrospective chart review of 103 charts belonging to children aged between 2 months and 18 years who were treated at UCI from January 1997 to December 2006. STUDY SITE: Uganda Cancer Institute located at Mulago national referral hospital. METHODOLOGY: Children’s charts with a diagnosis of acute leukemia were obtained with the assistance of the cancer registrar. Inormation on the social demographics, clinical symptoms, signs, haematological and radiological parameters at admission to UCI were abstracted from the charts. The outcome measures were initial response and outcome at 2 years and 5 years. RESULTS: A total of 103 charts were reviewed. The commonest clinical features of acute leukemias were anaemia (93.2%) and fever (89.3%). The initial treatment response rate for ALL and AML were; 39.7% and 26.7% respectively. Majority 77/103 (74.8%) reported lack of funds to purchase induction chemotherapy. The overall cure rate at 2 years was 20.4% {for ALL-17.5% and AML-2.9%} and the overall mortality rate was 79.6% {for ALL-(68%) and (11.6%) for AML }. At five years from diagnosis, there were no survivors for both types of acute leukemia. The median survival time for AML and ALL were 1.61 months and 3.29 months respectively. Factors independently associated with poor outcome included: age>_10 years at diagnosis {p=0.002}, Presence of severe anaemia with a haemoglobin concentration of <7g/dl {p=0.008}. CONCLUSIONS: The commonest clinical features of acute leukemia were persistent fever and anaemia Initial treatment response of ALL and AML was 39.7% and 26.7% respectively The overall cure rate of acute leukemia at 2 years was 20.4% and the mortality rate was 79.6% with no survivors at 5 years Factors associated with a poor outcome in our setting included age group >_ 10 years and severe anaemia with a haemoglobin concentration of less than 7g/dl Majority (74.8%) of patients could not afford drugs for induction therapy. RECOMMENDATIONS: Children presenting with persistent fever and anemia should be screened for acute leukemia Efforts should be made to provide comprehensive and holistic care to children with acute leukemia in order to improve the cure rate Prospective studies should be done to establish the various subtypes of acute leukemia, their clinical presentation and factors affecting their outcome in order to enable effective treatment regimens to be designed.