TREATMENT OF CHILDHOOD ACUTE LYMPHOBLASTIC LEUKEMIA IN IRAQ: A 17-YEAR EXPERIENCE FROM A SINGLE CENTER

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Background: About 300 childhood cancer cases are diagnosed annually at the Children Welfare Teaching Hospital (CWTH) in Baghdad, Iraq, and aproximately 32% are acute lymphoblastic leukemia (ALL). Procedure: We performed a retrospective single-center analysis of 1415 ALL children ranging from 1 to 15 years, diagnosed between January 2000 and December 2016. Patients were divided into three cohorts according to treatment period (2000-2005; 2006-2011; 2012-2016). Treatment protocols were based on three consecutive, modified and locally adapted pediatric UKALL protocols (-97, -2003, -2011); a 7-day steroid pre-phase was introduced for all patients from September 2008. Results: The overall complete remission (CR) rate was 86%. It progressively increased from 80% to 91% in the last study period. Early deaths occurred in 10% of children, decreasing from 12% to 6%, over time. Induction treatment abandonment rate was 3%. Relapse occurred in 23% of children. Toxic deaths and overall treatment abandonment in CR were 8% and 13%, respectively. Remission deaths remained unchanged, while abandonments decreased from 23% to 6% over time. At a median follow-up of 65.3 months, with abandonment considered as an event, the 5-year overall survival and event-free survival were 62.2% and 46.3%, and were statistically influenced by the treatment period. Conclusions: Though pediatric ALL survival in Iraq is still below that observed in high income countries, survival rates have progressively improved. Toxic deaths remain an important cause of failure. Pediatric oncologists fully dedicated to the improvement of patients’ care have significantly contributed to lower rates of early deaths, abandonment and treatment failures.

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