A Survival Analysis of Pediatric Acute Lymphoblastic Leukemia in Morocco

Bennani Mechita, Nada; Hessissen, Laila; Cherkaoui, Siham; Benmiloud, Sara; Kili, Amina; Abouselham, Loubna; Maani, Khadija; El Houdzi, Jamila; Benajiba, Noufissa; Lahlimi, Fatima Ezzahra; Khoubila, Nissrine; EL Alaoui El Hanafi, Mounia; Ghanam, Ayad; Tazi, Illias; Madani, Abdellah; Belakhel, Latefa; Khattab, Mohammed; Harif, Mhamed; Youbi, Mohammed; El Kababri, Maria

doi:10.31557/APJCP.2025.26.11.4053

A Survival Analysis of Pediatric Acute Lymphoblastic Leukemia in Morocco

Document Type : Research Articles

Authors

¹ Laboratory of Community Health, Preventive Medicine and Hygiene. Department of Public Health, Faculty of Medicine and Pharmacy, Mohammed V University in Rabat. Morocco.

² Laboratory of Biostatistics, Clinical Research and Epidemiology. Department of Public Health, Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Morocco.

³ Moroccan Society of Pediatric Hematology and Oncology, Morocco.

⁴ Pediatric Hematology and Oncology Department. Children Hospital of Rabat. Mohammed V University. Rabat. Morocco.

⁵ Hematology and Pediatric Oncology Department. 20 August Hospital of Casablanca. Morocco.

⁶ Pediatric Hematology and Oncology Unit. University Hospital Hassan II, Fès. Morocco.

⁷ Directorate of Epidemiology and Disease Control. Ministry of Health and Social Protection. Morocco.

⁸ Pediatric Hematology and Oncology Unit. Abderrahim El Harouchi Hospital of Casablanca, Morocco.

⁹ Pediatric Hematology and Oncology Department. Hospital Mohamed VI, Marrakech, Morocco.

¹⁰ Pediatric Hematology and Oncology Department. Mohammed VI University Hospital, Oujda, Morocco.

¹¹ Hematology Department, Chu Mohamed VI, Cadi Ayyad University, Marrakech, Morocco.

¹² Pediatric Hematology and Oncology. Cheikh Zaid University Hospital/Abulcasis University. Rabat, Morocco.

¹³ University Hospital Center of Tangier, Morocco.

10.31557/APJCP.2025.26.11.4053

Abstract

Background: As a WHO’s Global Initiative for Childhood Cancer pilot site, Morocco conducted a study on the overall survival rates of the six WHO index diseases. The objectives of this study were to estimate the survival rates for childhood acute lymphoblastic leukemia (ALL) diagnosed at Moroccan Pediatric Hematology and Oncology (PHO) centers, to identify factors of treatment failure, and to explore opportunities for improvement. Methods: This retrospective study included children with ALL aged 0-15 years. Patients were monitored with active follow-up until March 31, 2023. The Kaplan Meier method was used to estimate survival rates, the log-rank test to compare survival, and the Cox model to identify prognostic factors. Results: Data included 425 patients; most were aged 1-10years (n=318, 74.9%), and males (n=239, 56.2%). The complete remission induction rate was 84%. One-, three- and five-year overall survival rates were 78.7%, 63.8% and 60.8%, respectively. In a multivariate Cox model regression, age group, phenotype, complete remission following induction and white blood cell count > 50,000/mm3 were statistically associated with survival. Children with T-cell ALL were also more likely to die compared to those with B-cell ALL (HR=2.33 p<0.001). Conclusion: The 5-year survival rate in our study was 60.8%, below Morocco’s 80% target by 2030. Among 203 events, 86 were relapses, 34 resulted from treatment abandonment, and 55 from treatment-related toxicity. While relapse is the leading cause of treatment failure, prioritizing the reduction of treatment abandonment and toxicity-related mortality is a more feasible first step.

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