Prevalence of induction failure in children with Acute Lymphoblastic Leukemia (ALL) at a public tertiary facility in Kenya

Abstract

Objective: The aim of this study was to determine the prevalence of induction failure in Acute Lymphoblastic Leukaemia (ALL) and identify patient, disease and treatment factors associated with induction failure.
Study design, setting and duration: A retrospective cross-sectional study carried out at the Paediatric medical and oncology wards within Kenyatta National Hospital (Kenya’s largest public tertiary facility). Total population sampling was carried out between March 2020-April 2021.
Subjects: Paediatric patients aged 0 to 15 years with acute lymphoblastic leukaemia treated in KNH between January 2015 - December 2019. These children required a confirmed diagnosis of ALL on marrow cytology and end of induction remission status as evidenced on a marrow cytology. Children were excluded if there were incomplete medical records or death prior to start of induction.
Outcomes: Full blood count parameters, bone marrow cytology, Cerebrospinal fluid analysis at baseline and post induction. Induction regimen used and reasons for treatment interruptions.
Results: Induction failure was seen in 32.4% of sampled children with a case fatality rate of 10% (n=12). Central nervous system disease increased fourfold the risk of induction failure (OR 3.43 95%CI 1.33-1.86). This study did not find any association between induction failure and demographic characteristics of patients such as gender, age, and BMI.
Conclusion: The prevalence of induction failure was high in children diagnosed and treated for ALL in KNH. This is comparable to findings in other low-and middle-income countries. CNS disease was the only factor associated with induction failure.