Shimizu Koki, Luhulla Koga, Msoffe Magreth, Chambega Chambega, Mahawi Salama, Ewald Primus, Sandi Godlove, Msirikale Irene, Philbert Ruchius, Kabona Regina, Chirande Lulu, Nakiddu Nana Jacqueline, Scanlan Patricia, Smith Chris, Miyazaki Yasushi, Maringe Camille, Rachet Bernard, Mwamtemi Hadija
School of Tropical Medicine and Global Health, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan.
Inequalities in Cancer Outcomes Network (ICON), Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
Trop Med Health. 2025 May 27;53(1):76. doi: 10.1186/s41182-025-00760-2.
A wide inequality exists between high- and low-income countries in the outcome of paediatric acute lymphoblastic leukaemia (ALL). At a tertiary-level hospital in Tanzania, multidimensional approaches have been taken to improve cancer care for children. This study aimed to update the outcomes of paediatric ALL at Muhimbili National Hospital (MNH), Tanzania from 2016 to 2020.
We performed a retrospective chart review of children who were treated with modified UKALL2003 protocol at MNH from January 1, 2016 to December 31, 2020. We used the Cox proportional hazards model to estimate the effect of each prognostic factor on event-free survival (EFS).
We identified 202 patients who had confirmatory diagnoses of ALL and initiated treatment at MNH. Fifty-two patients (26%, 52/202) died (n = 47) or abandoned treatment (n = 5) before the end of remission induction. The main causes of death during this period were infections and bleeding complications. The median EFS was 9 months and 2-year EFS was 36%. Oedema, non-early rapid responder, and non-remission were associated with short EFS in the multivariable analysis.
The number of new paediatric ALL admissions at MNH has doubled in the past decade. The prevention of early deaths is critical to improve the long-term survival of paediatric ALL in Tanzania.
高收入国家和低收入国家在小儿急性淋巴细胞白血病（ALL）的治疗结果方面存在巨大差距。在坦桑尼亚的一家三级医院，已采取多维度方法来改善儿童癌症护理。本研究旨在更新2016年至2020年坦桑尼亚穆希姆比利国家医院（MNH）小儿ALL的治疗结果。
我们对2016年1月1日至2020年12月31日在MNH接受改良UKALL2003方案治疗的儿童进行了回顾性病历审查。我们使用Cox比例风险模型来估计每个预后因素对无事件生存期（EFS）的影响。
我们确定了202例确诊为ALL并在MNH开始治疗的患者。52例患者（26%，52/202）在缓解诱导期结束前死亡（n = 47）或放弃治疗（n = 5）。在此期间死亡的主要原因是感染和出血并发症。EFS的中位数为9个月，2年EFS为36%。在多变量分析中，水肿、非早期快速反应者和未缓解与EFS短相关。
在过去十年中，MNH新收治的小儿ALL患者数量增加了一倍。预防早期死亡对于提高坦桑尼亚小儿ALL的长期生存率至关重要。
