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Outcomes of Low-Intensity Treatment of Acute Lymphoblastic Leukemia at Butaro Cancer Center of Excellence in Rwanda

PURPOSE: Children with acute lymphoblastic leukemia (ALL) in low-income countries have disproportionately lower cure rates than those in high-income countries. At Butaro Cancer Center of Excellence (BCCOE), physicians treated patients with ALL with the first arm of the Hunger Protocol, a graduated-i...

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Autores principales: Rubagumya, Fidel, Xu, Mary Jue, May, Leana, Driscoll, Caitlin, Uwizeye, Frank Regis, Shyirambere, Cyprien, Larrabee, Katherine, Fehr, Alexandra E., Gilbert, Umuhizi Denis, Muhayimana, Clemence, Hategekimana, Vedaste, Elmore, Shekinah, Mpunga, Tharcisse, Moore, Molly, Shulman, Lawrence N., Lehmann, Leslie
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Society of Clinical Oncology 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6180843/
https://www.ncbi.nlm.nih.gov/pubmed/30241148
http://dx.doi.org/10.1200/JGO.2017.009290
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author Rubagumya, Fidel
Xu, Mary Jue
May, Leana
Driscoll, Caitlin
Uwizeye, Frank Regis
Shyirambere, Cyprien
Larrabee, Katherine
Fehr, Alexandra E.
Gilbert, Umuhizi Denis
Muhayimana, Clemence
Hategekimana, Vedaste
Elmore, Shekinah
Mpunga, Tharcisse
Moore, Molly
Shulman, Lawrence N.
Lehmann, Leslie
author_facet Rubagumya, Fidel
Xu, Mary Jue
May, Leana
Driscoll, Caitlin
Uwizeye, Frank Regis
Shyirambere, Cyprien
Larrabee, Katherine
Fehr, Alexandra E.
Gilbert, Umuhizi Denis
Muhayimana, Clemence
Hategekimana, Vedaste
Elmore, Shekinah
Mpunga, Tharcisse
Moore, Molly
Shulman, Lawrence N.
Lehmann, Leslie
author_sort Rubagumya, Fidel
collection PubMed
description PURPOSE: Children with acute lymphoblastic leukemia (ALL) in low-income countries have disproportionately lower cure rates than those in high-income countries. At Butaro Cancer Center of Excellence (BCCOE), physicians treated patients with ALL with the first arm of the Hunger Protocol, a graduated-intensity method tailored for resource-limited settings. This article provides the first published outcomes, to our knowledge, of patients with ALL treated with this protocol. METHODS: This is a retrospective descriptive study of patients with ALL enrolled at BCCOE from July 1, 2012 to June 30, 2014; data were collected through December 31, 2015. Descriptive statistics were used to calculate patient demographics, disease characteristics, and outcomes; event-free survival was assessed at 2 years using the Kaplan-Meier method. RESULTS: Forty-two consecutive patients with ALL were included. At the end of the study period, 19% (eight) were alive without evidence of relapse: three completed treatment and five were continuing treatment. Among the remaining patients, 71% (30) had died and 10% (four) were lost to follow-up. A total of 83% (25) of the deaths were disease related, 3% (one) treatment-related, and 13% (four) unclear. Event-free survival was 22% (95% CI, 11% to 36%), considering lost to follow-up as an event, and 26% (95% CI, 13% to 41%) if lost to follow-up is censored. CONCLUSION: As expected, relapse was the major cause of failure with this low-intensity regimen. However, toxicity was acceptably low, and BCCOE has decided to advance to intensity level 2. These results reflect the necessity of a data-driven approach and a continual improvement process to care for complex patients in resource-constrained settings.
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spelling pubmed-61808432018-11-13 Outcomes of Low-Intensity Treatment of Acute Lymphoblastic Leukemia at Butaro Cancer Center of Excellence in Rwanda Rubagumya, Fidel Xu, Mary Jue May, Leana Driscoll, Caitlin Uwizeye, Frank Regis Shyirambere, Cyprien Larrabee, Katherine Fehr, Alexandra E. Gilbert, Umuhizi Denis Muhayimana, Clemence Hategekimana, Vedaste Elmore, Shekinah Mpunga, Tharcisse Moore, Molly Shulman, Lawrence N. Lehmann, Leslie J Glob Oncol ORIGINAL REPORTS PURPOSE: Children with acute lymphoblastic leukemia (ALL) in low-income countries have disproportionately lower cure rates than those in high-income countries. At Butaro Cancer Center of Excellence (BCCOE), physicians treated patients with ALL with the first arm of the Hunger Protocol, a graduated-intensity method tailored for resource-limited settings. This article provides the first published outcomes, to our knowledge, of patients with ALL treated with this protocol. METHODS: This is a retrospective descriptive study of patients with ALL enrolled at BCCOE from July 1, 2012 to June 30, 2014; data were collected through December 31, 2015. Descriptive statistics were used to calculate patient demographics, disease characteristics, and outcomes; event-free survival was assessed at 2 years using the Kaplan-Meier method. RESULTS: Forty-two consecutive patients with ALL were included. At the end of the study period, 19% (eight) were alive without evidence of relapse: three completed treatment and five were continuing treatment. Among the remaining patients, 71% (30) had died and 10% (four) were lost to follow-up. A total of 83% (25) of the deaths were disease related, 3% (one) treatment-related, and 13% (four) unclear. Event-free survival was 22% (95% CI, 11% to 36%), considering lost to follow-up as an event, and 26% (95% CI, 13% to 41%) if lost to follow-up is censored. CONCLUSION: As expected, relapse was the major cause of failure with this low-intensity regimen. However, toxicity was acceptably low, and BCCOE has decided to advance to intensity level 2. These results reflect the necessity of a data-driven approach and a continual improvement process to care for complex patients in resource-constrained settings. American Society of Clinical Oncology 2017-10-30 /pmc/articles/PMC6180843/ /pubmed/30241148 http://dx.doi.org/10.1200/JGO.2017.009290 Text en © 2017 by American Society of Clinical Oncology http://creativecommons.org/licenses/by/4.0/ Licensed under the Creative Commons Attribution 4.0 License: http://creativecommons.org/licenses/by/4.0/
spellingShingle ORIGINAL REPORTS
Rubagumya, Fidel
Xu, Mary Jue
May, Leana
Driscoll, Caitlin
Uwizeye, Frank Regis
Shyirambere, Cyprien
Larrabee, Katherine
Fehr, Alexandra E.
Gilbert, Umuhizi Denis
Muhayimana, Clemence
Hategekimana, Vedaste
Elmore, Shekinah
Mpunga, Tharcisse
Moore, Molly
Shulman, Lawrence N.
Lehmann, Leslie
Outcomes of Low-Intensity Treatment of Acute Lymphoblastic Leukemia at Butaro Cancer Center of Excellence in Rwanda
title Outcomes of Low-Intensity Treatment of Acute Lymphoblastic Leukemia at Butaro Cancer Center of Excellence in Rwanda
title_full Outcomes of Low-Intensity Treatment of Acute Lymphoblastic Leukemia at Butaro Cancer Center of Excellence in Rwanda
title_fullStr Outcomes of Low-Intensity Treatment of Acute Lymphoblastic Leukemia at Butaro Cancer Center of Excellence in Rwanda
title_full_unstemmed Outcomes of Low-Intensity Treatment of Acute Lymphoblastic Leukemia at Butaro Cancer Center of Excellence in Rwanda
title_short Outcomes of Low-Intensity Treatment of Acute Lymphoblastic Leukemia at Butaro Cancer Center of Excellence in Rwanda
title_sort outcomes of low-intensity treatment of acute lymphoblastic leukemia at butaro cancer center of excellence in rwanda
topic ORIGINAL REPORTS
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6180843/
https://www.ncbi.nlm.nih.gov/pubmed/30241148
http://dx.doi.org/10.1200/JGO.2017.009290
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