Pediatrician and Child Health Specialist, Addis Ababa, Ethiopia.
Department of Pediatrics and Child Health, School of Medicine, Addis Ababa University, P.O. Box 9080, Addis Ababa, Ethiopia.
BMC Cancer. 2024 May 24;24(1):640. doi: 10.1186/s12885-024-12404-5.
Pediatric Acute Myeloid Leukemia (AML) is a major cause of morbidity and mortality in children with cancer in Africa and other developing continents. Systemic chemotherapy and effective supportive care have significantly contributed to increased survival rates of pediatric AML in developed countries reaching approximately 70%. There is a paucity of contextual data regarding overall and event-free survival outcomes in children with acute myeloid leukemia in developing countries and most centers in Africa provide palliative care. The objective of this study was to assess the overall survival, event-free survival, and associated factors in pediatric AML patients treated in Ethiopia.
This retrospective study was conducted on Pediatric AML patients treated at Tikur Anbessa Hospital between January 1, 2015, and May 30, 2022. The socio-demographic profile of patients, the clinical characteristics, the biochemical and morphological subtypes of AML were analyzed using SPSS version 25. The Kaplan-Meier survival curve was used to estimate the probabilities of overall and event-free survival. Statistical significance was set at p < 0.05.
A total of 92 children with AML were included in this study. The median age at diagnosis was 7 years (interquartile range: 5-10 years) with a slight male predominance. The median duration of symptoms was one month. Neutropenic fever (56, 86.2%) was the most common complication during treatment. About 29.3% of the patients succumbed to early death. The corresponding 1-year and 3-year OS probabilities were 28.2% and 23% respectively. The median event-free survival time for all pediatric AML patients was one-month (95% CI: 0.77-1.23). The determinants of poorer survival outcomes were FAB subtype, type of protocol used, and signs of CNS involvement (p < 0.05).
The survival rates of children from AML were low in the study setting. More than 25% of AML patients succumbed to early death, and febrile neutropenia was the most common complication. Effective supportive and therapeutic measures should be taken to manage febrile neutropenia and to prevent early death in AML patients.
小儿急性髓细胞白血病（AML）是非洲和其他发展中大陆儿童癌症发病率和死亡率的主要原因。系统化疗和有效的支持性护理显著提高了发达国家小儿 AML 的生存率，达到了约 70%。关于发展中国家儿童急性髓细胞白血病的总体生存率和无事件生存率，相关数据很少，而且非洲的大多数中心都提供姑息治疗。本研究的目的是评估在埃塞俄比亚接受治疗的小儿 AML 患者的总体生存率、无事件生存率和相关因素。
这是一项回顾性研究，对 2015 年 1 月 1 日至 2022 年 5 月 30 日在提克里安贝萨医院接受治疗的小儿 AML 患者进行了研究。使用 SPSS 25 版分析患者的社会人口统计学特征、临床特征、AML 的生化和形态学亚型。使用 Kaplan-Meier 生存曲线估计总体生存率和无事件生存率。统计显著性设为 p<0.05。
共有 92 例 AML 患儿纳入本研究。诊断时的中位年龄为 7 岁（四分位距：5-10 岁），男性略占优势。中位症状持续时间为一个月。治疗期间最常见的并发症是中性粒细胞减少性发热（56 例，86.2%）。约 29.3%的患者早期死亡。相应的 1 年和 3 年 OS 概率分别为 28.2%和 23%。所有小儿 AML 患者的中位无事件生存时间为 1 个月（95%CI：0.77-1.23）。较差的生存结果的决定因素是 FAB 亚型、使用的方案类型和 CNS 受累的迹象（p<0.05）。
研究环境中儿童 AML 的生存率较低。超过 25%的 AML 患者死于早期，中性粒细胞减少性发热是最常见的并发症。应采取有效的支持和治疗措施来管理中性粒细胞减少性发热，并预防 AML 患者的早期死亡。
