Epidemiology and Clinical Features of Pediatric AML in Uganda: Retrospective Study

Overview

This retrospective study analyzed 219 pediatric acute myeloid leukemia (AML) cases in Uganda from 2016 to 2022, revealing an estimated incidence of 1.2 cases per million children annually. The study highlights the predominance of FAB M2 subtype, frequent clinical presentations including fever and pallor, and significant challenges in diagnosis due to limited diagnostic resources.

Background

Pediatric AML constitutes approximately 20–25% of acute leukemia globally, with incidence varying by region and ethnicity. In low- and middle-income countries like Uganda, AML is underreported due to diagnostic limitations and lack of comprehensive cancer registries. Diagnosis often relies on clinical assessment and bone marrow morphology using FAB classification, as advanced cytogenetic and molecular testing is largely unavailable. Understanding the epidemiology and clinical features in Uganda is critical to improving recognition and management.

Data Highlights

Key Findings

• The estimated incidence of pediatric AML in Uganda is approximately 1.2 cases per million children annually, likely underestimated due to diagnostic challenges.
• The median age at diagnosis was 7 years, with a slight male predominance.
• FAB M2 subtype was the most frequent morphological classification, followed by M4 and M5.
• Common clinical manifestations included fever, pallor, and bleeding; CNS involvement was present in nearly 9% of cases.
• Severe malnutrition was observed in over a quarter of patients, potentially impacting outcomes.
• Diagnostic capacity limitations necessitated reliance on morphology and clinical features, with minimal use of flow cytometry and cytogenetics.

Clinical Implications

Clinicians in Uganda and similar resource-limited settings should maintain a high index of suspicion for AML in children presenting with fever, pallor, and bleeding, especially given the high prevalence of the M2 subtype. Early recognition and referral are critical, despite limited access to advanced diagnostics. Addressing malnutrition and improving diagnostic infrastructure could enhance patient outcomes.

Conclusion

This study provides valuable epidemiological and clinical insights into pediatric AML in Uganda, underscoring the need for improved diagnostic capabilities and awareness to facilitate timely diagnosis and treatment. Enhanced data collection and resource allocation are essential to better define and manage pediatric AML in low-resource settings.

Related Resources & Content

1. Ugandan Pediatric AML Study Group 2025 -- Epidemiology, clinical manifestations, and hematological features of pediatric acute myeloid leukemia in Uganda