Childhood acute leukemia in Tanzania; clinical presentation, hematological parameters and survival rate two years from diagnosis.

Abstract

Background: Acute childhood leukemia is a progressive malignant disease of the blood forming tissues arising within the bone marrow, characterized by the uncontrolled proliferation of immature leukocytes and their precursors replacing the normal hematopoietic cells of the bone marrow leading to bone marrow failure. There are two main types of acute leukaemia i.e. Acute Lymphoblastic Leukaemia (ALL) in which lymphoid progenitor cells undergo dysregulated proliferation, with clonal expansion and accounts for 77% of all leukemias occurring in children. Acute Myeloid Leukaemia (AML) on other hand is myeloid dysregulation and accounts for 11% of cases of childhood leukemias. With modern scientific and technological advances cure rate for childhood leukemia is possible in 90% among those with ALL and 76% among those with AML. However, in countries with limited resources cure rates are relatively lower. Description of the clinical presentation and survival rate of children with acute leukemia in Tanzanian is important so that necessary changes can be made to improve the outcome. In Tanzania there is lack of data on the clinical presentation, and survival rate of children with acute leukemia. Objective: The broad objective of this study was to determine the clinical presentation, hematological parameters and survival rate two years from diagnosis in children aged less than 18 years with acute leukemia in Tanzania. Materials and Methods: A retrospective hospital based cohort study was conducted at Ocean Road Cancer Institute (ORCI) and Muhimbili National Hospital (MNH), Dar Es Salaam (DSM) Tanzania, including data from 1st January 2008 to 31st December 2011. Data were collected from patient files using a questionnaire. Data collected were analyzed using statistical package for the social sciences (SPSS) version 20. Results: A total of 193 patients’ files were reviewed during this study. More than half of the patients were males (56.5%) with male to female ratio of 1.3: 1. Mean age at presentation was 8.23 years ± 4.73SD. (Range 1 – 18 years), 68.4% were 10 years and below. Majority (79.8 %) had ALL of which 56 % were males with mean age of 7.82 yrs ±4.49SD, for AML the mean age was 9.87 yrs ± 5.33 SD. Common presenting features were found to be pallor/anemia (78.8%), fever and lymphadenopathy (70.5%), splenomegally (56%) and hepatomegally (53.4%). Thirty two percent had White Blood Cell (WBC) count >50 K/ul, 23% had platelet count <20 K/ul and 60% had severe anemia. For ALL survival rate was 66% at one year and 40% at two years from diagnosis; and for AML survival rate was 19% at one year and there was no survivor at two years from diagnosis. Conclusions: Childhood acute leukemia in ORCI and MNH Tanzania commonly presents with pallor/anemia, fever and lymphadenopathy. More than half of the patients presented with severe anemia, splenomegaly and hepatomegaly. WBC count >50 K/ul is highly associated with increased mortality. Two years survival rate from diagnosis is poor especially for AML. Recommendations: Clinicians should have a high index of suspicion for acute leukemia for children who present with persistent fever and anemia. Community health education is required in order to increase community awareness and to emphasize on early health care seeking behavior.