Abstract 80: Outcomes of Acute Lymphoblastic Leukemia among Adolescents and Young Adults in Malawi

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Abstract Purpose: There is limited data on treatment and outcomes for acute lymphoblastic leukemia (ALL) among adolescents and young adults (AYA) in sub-Saharan Africa. We describe a prospective observational cohort in Malawi. Methods: Patients aged 14 - 39 years old with untreated acute lymphoblastic leukemia at Kamuzu Central Hospital, Malawi, underwent comprehensive clinicopathologic evaluation at baseline. ALL diagnosis was confirmed onsite using immunohistochemical (IHC) and telepathology consultations involving pathologists in Malawi and the United States. Patients were treated with a modified regimen for AYA modeled after the CALGB10403 protocol. Key modifications included omission of asparaginase and hematopoietic growth factors due to unavailability, and no dose escalation for methotrexate during interim maintenance. Post-induction remission was confirmed via bone marrow biopsy. Results: From 2015 to 2019, we enrolled 19 patients. Thirteen (68%) were female, and the median age was 19 years (IQR 17-27). Sixteen (84%) had extramedullary involvement, 10 (53%) had ECOG ≥2, and 11 (58%) had T-cell immunophenotype. None were HIV infected. Four patients died before initiating treatment. Out of 15 patients who initiated treatment, 10 completed induction, of whom 9 achieved remission. The median treatment duration was 8 months (range 0-29). After a median follow-up time of 9 months (range 1-29), no patients were lost to follow-up. Two patients (10%) remain in remission on maintenance therapy after 8 and 29 months, respectively, and 17 (89 %) have died, all from disease progression. OS at 1 year is 31.5% (95% CI 15-64%) and at 2 years is 10.5% (95% CI 3-40%). Conclusion: Findings were poor but in line with those among pediatric ALL patients from the region. Given no toxicity-related mortality occurred, escalation of therapy is needed and being implemented. Our experience demonstrates that it is possible to achieve modest results using a complex ambulatory chemotherapy regimen modified to resource availability. Citation Format: Stephen Kimani, Matthew Painschab, Edwards Kasokanji, Grace Ellis. Outcomes of Acute Lymphoblastic Leukemia among Adolescents and Young Adults in Malawi [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 80.

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