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Childhood acute lymphoblastic leukemia in sub Saharan Africa: 4 years? experience at the pediatric oncology unit Bamako, Mali

Togo B*, Traore F, Doumbia AK, Togo P, Diall H, Maiga B, Sacko K, Konate D, Coulibaly O

Introduction: Childhood acute lymphoblastic Leukemias (ALL) is relatively rare in sub-Saharan Africa but probably underdiagnosed. The aim of this work was to describe the epidemiological, clinical, and therapeutic aspects of ALL in the pediatric oncology unit of Bamako.

Patients and Methods: It was a retrospective, descriptive study on 33 children with ALL, treated at the pediatric oncology unit of Bamako according to a protocol developped by the French African Pediatric Oncology Group (FAPOG).

Results: The mean age of patients was 10 years with extremes of 2 and 15 years and a sex ratio (M/F) of 3.7. The majority of patients were over 5 years of age (79%). Clinically, pallor was noted in 72% of cases, fever in 79% and 24% had a hemorrhagic syndrome. Biologically, the tumor lysis was present in all patients, all patients hemoglobin level less than 10 g/dl, 91% had thrombocytopenia and 51% had leukocytosis (>50 Giga/l). Complete remission at the end of induction was 64%, with 27% of early deaths. After a mean follow-up time of two years, we recorded 12% of loss of follow-up and 82% of deaths. The global survival was 6%.

Conclusion: Childhood ALL have a very poor prognosis in Mali. Early diagnosis and adapted protocols to high risk patients will help reduce early deaths and improve the survival of patients in remission.