Abstract Ref Number = APCP86
Pediatric AML Treatment Strategy and Challenge in Indonesia
Pediatric Hematology Oncology, Dr Sardjito Hospital MedicalPublic Health and Nursing Faculty Universitas Gadjah Mada, Yogyakarta, Indonesia
The prognosis for children with acute myeloid leukemia (AML) has improved greatly over the last three decades but the survival gap of childhood cancer between developed and developing countries is still wide. Treatment result of childhood acute myeloid leukemia (AML) in developing countries is estimated to be below 10% while developed countries now increasing up to 70%.
In developing countries/low-to-income countries (LMIC), limited resources and variable infrastructure, including suboptimal risk stratification, supportive care, and disproportionate number of patients for the available number of, physicians, nurses and hospital beds s result in a various outcome One of many various variables which influenced outcome is that there is no standard induction chemotherapy regime for treatment of pediatric AML. There is lack of available evidence from the literature that shows superiority of a three drug over a two-drug induction chemotherapy regimen in pediatric AML. In these circumstances, there is also a paucity of data on outcome in pediatric AML from developing countries like Indonesia.
Treatment of AML in resource poor settings is challenging because of lack of supportive care facilities included: availability and continuity of chemotherapy drugs, infection control facilities such as: isolation room, availability of antibiotics and antifungal. Other factors influenced are blood bank facilities, high cost of treatment and poor access to stem cell transplantation. We have developed and implemented a National Protocol for pediatric AML in Indonesia, starting 2011, and now is still ongoing for evaluation to improve the outcome. In an interim report of national protocol, infection was the most common factor causing death. While in general, treatment with National AML protocol resulted in a higher survival rate compared to the non-national AML protocols. However, overall outcome still was very poor. Improved supportive care including blood transfusions, prevention and treatment of infections most likely are key to success in the treatment of AML.
Keywords: AML, challenge, limited resources country, treatment strategy