Significant Impact of Treatment Abandonment on Survival of Children With “Common and Curable” GICC Index Cancers in Sub-Saharan Africa—A Multicenter Prospective CANCaRe Africa Study

IF 2.3 3区医学 Q2 HEMATOLOGY

Pediatric Blood & Cancer Pub Date : 2025-09-03 DOI:10.1002/pbc.31997

Mulugeta Yimer, Diriba Fufa, Festus Njuguna, Cecilia Mdoka, George Chagaluka, Elizabeth Molyneux, Francine Kouya, Lillian Sung, Vivian Paintsil, Barnabas Atwiine, Trijn Israels

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Abstract

Background

The World Health Organization Global Initiative for Childhood Cancer (GICC) targets a global survival rate of 60% for childhood cancer, focusing initially on six common, curable cancers. This study describes survival rates of five of these cancers in sub-Saharan Africa and assesses the impact of treatment abandonment (TxA).

Methods

This multicenter, prospective, observational cohort study included newly diagnosed children (<16 years) with Burkitt lymphoma (BL), acute lymphoblastic leukemia (ALL), Wilms tumor (WT), retinoblastoma (RB), or Hodgkin lymphoma (HL), enrolled between January and December 2022 from seven hospitals in Malawi, Ethiopia (n = 2), Ghana, Kenya, Uganda, and Cameroon. Two-year event-free survival (EFS) and treatment abandonment rates were analyzed.

Results

Of 366 patients enrolled (median age 7.0 years, 64% males), Burkitt lymphoma was most common (30%, 108/366). Median follow-up was 27.6 months (range: 8–37.4). Treatment abandonment occurred in 24% of patients (89/366), highest in RB patients (38%, 15/39). Overall 2-year EFS was 40.8% ± 2.7%, improving to 59.2% ± 3.0% when TxA cases were censored. EFS rates with TxA as an event were BL 39.1% ± 5.0%, ALL 27.4% ± 4.4%, WT 51.5% ± 5.4%, RB 39.9% ± 8.0%, and HL 68.5% ± 9.3%.

Conclusion

Survival for common, curable childhood cancers in sub-Saharan Africa remains low, averaging approximately 41% at 2 years, ranging from 27% (ALL) to 69% (HL). Treatment abandonment significantly impacts outcomes, affecting nearly 25% of patients. Preventing abandonment could potentially increase average survival to approximately 60%, emphasizing the need for effective intervention strategies.

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放弃治疗对撒哈拉以南非洲“常见和可治愈”GICC指数癌症儿童生存的显著影响——一项多中心前瞻性非洲癌症研究

背景：世界卫生组织儿童癌症全球倡议（GICC）的目标是儿童癌症的全球存活率达到60%，最初重点关注六种常见的可治愈癌症。这项研究描述了撒哈拉以南非洲五种癌症的存活率，并评估了放弃治疗的影响（TxA）。方法：这项多中心、前瞻性、观察性队列研究纳入了新诊断的儿童(结果：入组的366例患者（中位年龄7.0岁，男性64%）中，Burkitt淋巴瘤最为常见（30%,108/366）。中位随访时间为27.6个月（8-37.4个月）。24%的患者（89/366）放弃治疗，RB患者中最高（38%,15/39）。2年总EFS为40.8%±2.7%，剔除TxA病例后提高至59.2%±3.0%。以TxA为事件的EFS发生率为BL 39.1%±5.0%,ALL 27.4%±4.4%,WT 51.5%±5.4%,RB 39.9%±8.0%,HL 68.5%±9.3%。结论：在撒哈拉以南非洲地区，常见的、可治愈的儿童癌症的生存率仍然很低，2年平均约为41%，从27% （ALL）到69% （HL）不等。放弃治疗显著影响预后，影响近25%的患者。防止遗弃可能会将平均存活率提高到约60%，这强调了有效干预策略的必要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pediatric Blood & Cancer 医学-小儿科

CiteScore

4.90

自引率

9.40%

发文量

546

审稿时长

1.5 months

期刊介绍： Pediatric Blood & Cancer publishes the highest quality manuscripts describing basic and clinical investigations of blood disorders and malignant diseases of childhood including diagnosis, treatment, epidemiology, etiology, biology, and molecular and clinical genetics of these diseases as they affect children, adolescents, and young adults. Pediatric Blood & Cancer will also include studies on such treatment options as hematopoietic stem cell transplantation, immunology, and gene therapy.