A retrospective review of paediatric acute myeloid leukaemia at Chris Hani Baragwanath Academic Hospital in Johannesburg, South Africa

Abstract

Abstract Background and Aims: Survival gains in paediatric acute myeloid leukaemia (AML) in highincome countries (HIC) have not been mirrored in low- and middle-income countries (LMIC). This study aimed to determine the disease spectrum, outcome and complications of paediatric AML in a resource constrained oncological service in Johannesburg, South Africa.

Methods: From 1998 to 2017, the clinical details, treatment, outcome and complications of all paediatric patients with AML were analysed. Treatment was according to the Berlin-FrankfurtMunster (BFM) AML 1998 protocol.

Results: Over the 20-year study period 119 children, with a mean age of seven years, were diagnosed with AML. Fifty (42%) were classified as standard risk and 54 (45%) as high risk. Included in the cohort, were 23 patients diagnosed with Acute Promyelocytic Leukaemia (APL). Eighty-four (71%) patients died: 55 (65%) deaths were due to disease-related causes and 29 (35%) were due to sepsis. Forty-one (49%) of the deaths had occurred by the end of first induction. Infections during treatment were found in 93 (78%) patients and sepsis-related deaths increased from 19% to 29% over the two decades (p-value 0.29). Overall survival was 32% with an event free survival of 24%. The five-year survival rate for children with APL was 30%.

Conclusion: Paediatric AML survival was poor, with no improvement over the two decades. Induction and sepsis related mortality rates are unacceptably high. This data will be used to guide strategies to improve survival of paediatric AML in our setting. Targeting early mortality and children with APL have the potential for significant benefit.