Paediatric acute myeloid leukaemia epidemiology, treatment approaches, and outcomes in africa: A review of the literature

Paediatric acute myeloid leukaemia (AML) is a challenging disease in low- and middle-income countries with limited African data. This study reviewed the existing literature regarding paediatric AML in Africa. A literature search was performed using PubMed, Embase, Google Scholar, Research4Life, and African Journals Online for published studies on paediatric AML in Africa, with keywords acute myeloid leukaemia, children, Africa, and country-specific names for all the African countries. The review included all abstracts and publications from Africa from January 2004 until January 2024, involving children between 0 and 17 years old with outcome data. Of 164 studies identified, 22 were included in the data analysis, with 2230 children included. Treatment regimens varied widely. Complete remission rates ranged between 23.1% and 88.9% (median 55.0%) for AML in general and between 72.6% and 95.0% for acute promyelocytic leukaemia (APL). The results also showed high rates of early deaths (5 - 96%; median 29.3%) and treatment-related mortality rates (11.3 - 47.1%; median 21.0%) among children with AML in the African setting. The five-year probability of event-free survival ranged from 14.8% for high-risk disease to 69.4% for APL. The five-year probability of overall survival ranged between 14% and 31.9% for non-APL (median 29.5%). Treatment abandonment varied between 3% and 50% (median 12.7%). Only 14 patients received a hematopoietic stem cell transplantation. There is limited data regarding paediatric AML and outcomes in Africa, with variable treatment regimens, treatment outcomes, early deaths, treatment-related mortality, and abandonment rates. Adapted treatment protocols adjusted to local settings should be implemented with improved supportive health care.