Treatment of childhood acute lymphoblastic leukemia in Iraq: a 17-year experience from a single center

Abstract

We performed a retrospective analysis of 1415 acute lymphoblastic leukemia children diagnosed between January 2000 and December 2016 at Children Welfare Teaching Hospital, Baghdad, Iraq. Patients were divided into three cohorts according to treatment period (2000–2005; 2006–2011; 2012–2016). Treatments were based on modified-UKALL protocols; a steroid-pre-phase was introduced from September 2008. The overall complete remission was 86%, increased from 80% to 91% in the last period. Early deaths occurred in 10%, decreasing to 6%, overtime. Relapses were 23%; toxic deaths and abandonment 8% and 13%, respectively. At a median follow-up of 65.3 months, with abandonment considered as an event, the 5-year overall survival (OS) and event-free survival were 62.2% and 46.3%, statistically influenced by treatment period (5-year OS 62.6%, 59.1%, 66.3%; p=.057, respectively). Though pediatric ALL survival in Iraq is still below that observed in high income countries, survival rates progressively improved. Toxic deaths remain an important cause of failure.

Keywords:

• Acute lymphoblastic leukemia
• children
• low-income country
• telemedicine

Acknowledgements

The authors thank all patients and their families. The authors also thank the Italian non-governmental organization, INTERSOS, for the initial technical support to activate the telemedicine program and for specific training for Iraqi doctors in Rome, Italy.

Disclosure statement

The authors have no conflict of interest to declare.