Background. The treatment of childhood acute lymphoblastic leukemia
(ALL) remains challenging in low-income countries. Here we evaluate the
experience with a modified Berlin-Frankfurt-Münster (BFM) treatment
protocol ALL-Moscow Berlin (MB)-91 at the Kantha Bopha hospitals, a
charity-funded institution providing free pediatric care in Cambodia.
Methods. This is a retrospective study including 110 unselected patients
aged 9 months to 14 years diagnosed with ALL between 2015 and 2017.
Patients were stratified in high- (HR) and standard-risk (SR) groups
based on clinical criteria. The cumulative doses of anthracyclines were
reduced to 120 mg/m2 for SR patients and consolidation was based on
Capizzi methotrexate elements instead of cyclophosphamide, cytarabine
and high dose methotrexate. Supportive empiric antibiotic treatment and
whole blood transfusions were possible. Results. 63 patients (57 %)
were HR, mostly based on high leukemia burden with hyperleukocytosis
> 50 G/l, massive lymph node and hepato-splenic
involvement, reflecting a high disease burden. 72 patients (65.5%)
reached complete remission (CR) on day 36. The estimated 3-year overall
survival (OS) was 34.9 %, 50.5 % for SR and 23.4 % for HR patients.
Most events were due to severe infections (40 (53.3 %)) and bleeding
(15 (20 %)), mostly during induction and consolidation. Relapse was
confirmed in 13 cases (11.8 %). No patients abandoned treatment.
Conclusion. ALL chemotherapy is feasible in a charity-funded public
institution with results comparable to other low-middle income
countries, but treatment-related mortality remains limiting. This will
justify investments in diagnostics to stratify more patients for reduced
intensity treatment and in supportive care.