Childhood leukemia outcomes in a low-resource tertiary care setting

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Context Acute leukemia (AL) is the commonest hematological malignancy in childhood. The cause is largely multifactorial and unknown, with exogenous and endogenous factors interacting with genetic susceptibility. Its incidence is on the rise globally including developing countries like Nigeria. Although the prognosis in developed countries has improved, poor outcomes are still the norm in resource-poor areas. Aims This review was undertaken to document the sociodemographic characteristics, management challenges, and outcomes of leukemia in an African tertiary care setting. Settings and design The study was a retrospective review of patients managed for AL over a 30-month period. Patients and methods This is a retrospective review of clinical case notes of children admitted with diagnosis of AL. Results A total of 31 children had morphological diagnosis of AL; half of them had acute lymphoblastic leukemia, a third acute myeloid leukemia, and one-sixth bilineal leukemia, respectively. Most patients were from low socioeconomic status. All patients sought alternative or complimentary care, and source of health care expenditure was out of pocket. The mean duration of symptoms was 12.9±10.3, time to diagnosis in our hospital was 3.7±2.1 days, and duration of hospital stay was 36.7±43.4 days. The mean packed cell volume, white blood cell, and platelet counts were 14.2±5.3, 37.9±30.2×109/l, and 45.4±54.3×109/l, respectively. Only four patients attained remission of the 15 (48.4%) who received chemotherapy. The mortality was 11 (35.5%) cases, with eight cases being owing to hemorrhage from severe thrombocytopenia. Conclusions The study shows delay in time from symptoms to presentation, time to diagnosis, and commencement of chemotherapy with associated poor outcomes. All patients sought alternative and/or complementary interventions before presentation.