EFFECTIVENESS OF PACIFIC ISLAND (PI) TREATMENT PROTOCOLS ON TREATMENT OF CHILDHOOD ACUTE LYMPHOBLASTIC LEUKEMIA AND ACUTE PROMYELOCYTIC LEUKEMIA MANAGEMENT IN FIJI: A Cross Sectional Analysis: 2008 - 2018

Introduction: Leukemia is a malignant disease characterized by an uncontrolled abnormal overproduction of immature white blood cells in the bone marrow. It is the most common type of childhood cancer. Acute lymphoblastic leukemia (ALL) is the most common type of childhood leukemia second by acute myeloid leukemia (AML). ALL is locally treatable together with Acute Promyelocytic Leukemia (APML) which is a subtype of AML. They are treated using the PI treatment protocols. These are adapted protocols involving multi agents chemotherapy designed and introduced through our twinning partnership with New Zealand since 2008. It is not risk-based type of treatment which is gold standard. There have not been any evaluation of outcomes since implementation. This study aimed to evaluate the effectiveness of these protocols.
Method: This is a Cross sectional analysis of patients with ALL and APML that were treated with PI treatment protocols (PI ALL and PI APML) in Fiji from 2008 – 2018. All patient records of identified cases that didn’t meet exclusion criteria were reviewed and analysed in terms of treatment outcomes, treatement failures and complications.
Results: Overall outcomes of all ALL and APML cases that were treated were remission rate of 84%, survival 49%, cure 16% and treatment completion 44%. Overall treatment failures were mortality 51%, relapse 26%, abandonment 7% and refractory disease 5%. Outcomes of the 50 ALL patients treated were remission rate 86%, survival 52%, treatment completion 46%, cure 18%, mortality 48%, relapse 24%, abandonment 6% and refractory disease 4%. Outcomes of the 7 APML cases treated with PI APML protocol were remission 5, survival 2, treatment completion 2, mortality 5, relapse 3, abandonment 1, refractory disease 1 and no APML cases have been declared cured yet. The most common complications associated with these chemotherapies were febrile neutropenia, myelosuppression without fever and hairloss among others.
Conclusion: Treatment outcomes found are similar to those in other low-middle-income settings that treat similar cases. Overall cure rate of 16% and 18% of ALL is relatively low. PI treatment outcomes though when compared to pre-treatment era have improved, findings show that Fiji is not ready yet to graduate to a risk-based chemotherapy which is the gold standard in developed countries. The treatment outcomes, failures and complications evaluated will be used as a basis of discussion with our twinning partners in light of reviewing the current PI protocols and planning the way forward for us.