Abstract
Background Lower-middle-income countries face unique problems in the management of pediatric
acute myeloid leukemia (AML) due to which the outcomes have not kept pace with developed
nations. In India, data on childhood AML is sparsely available, thus making a true
assessment of disease trends difficult. The current systematic review was undertaken
to assess the outcomes of childhood AML from published literature from India over
a period of 10 years (2011–2021).
Materials and Methods A systematic search of MEDLINE, Google Scholar, and SCOPUS was performed as per preferred
reporting items for systematic reviews and meta-analyses (PRISMA) statement from January
1, 2011 to December 31, 2021. In addition, International Society of Pediatric Oncology
(SIOP) conference abstracts were also screened for relevant studies on AML from India.
This study was registered in PROSPERO (ID42021273218).
Results A total of 1,210 patients from 19 studies were included. Standard 3 + 7 and MRC AML
based regimens were commonly adopted regimens for induction. Remission rates varied
between 56 and 95%. Overall treatment-related mortality across studies was 23.2% (95%
confidence interval [CI]: 10.3–35.9%). The mean incidence of treatment abandonment
was 19.3% ( 95% CI: 10.9–27.5%). Event-free survival and overall survival were in
the range of 28 to 55% and 15 to 66%, respectively. Hematopoietic stem cell transplantation
was performed only on a small subset of patients.
Conclusion Outcomes of pediatric AML in India continue to be suboptimal with high treatment
abandonment and toxic deaths. Ensuring uniform access to therapy and supportive care
along with a robust social support system would improve outcomes of childhood AML
in India.
Keywords
acute myeloid leukemia - India - lower-middle-income countries - abandonment
