Clinical Scorecard: Epidemiology, clinical manifestations, and hematological features of pediatric acute myeloid leukemia in Uganda: a retrospective study

At a Glance

Key Highlights

• Pediatric AML accounts for approximately 20–25% of acute leukemia globally, with incidence peaks before 1 year and between 15-20 years.
• In Uganda, AML diagnosis relies mainly on clinical assessment and bone marrow morphology due to limited availability of cytogenetic and immunophenotypic testing.
• Challenges in Uganda include underreporting, lack of national pediatric cancer registry, and frequent misdiagnosis contributing to poor outcomes.

Guideline-Based Recommendations

Diagnosis

• Confirm AML diagnosis based on bone marrow and/or peripheral blood smear morphology using FAB classification.
• Use flow cytometry and cytogenetic/molecular testing when available, though often limited in resource-poor settings.
• Assess CNS involvement via cerebrospinal fluid analysis with >5 WBCs/mm3 and presence of blasts or clinical CNS symptoms.
• Diagnose myeloid sarcoma clinically based on AML diagnosis, lesion location, imaging features, and exclusion of other diagnoses.

Management

• Prompt recognition and referral by frontline clinicians and hematologist-oncologists to improve diagnosis and treatment outcomes.
• Nutritional status assessment using WHO z-scores to identify malnutrition which may impact treatment tolerance.

Monitoring & Follow-up

• Regular clinical and laboratory monitoring including WBC counts and LDH levels to assess disease status and response.
• Monitor CNS status through CSF analysis when clinically indicated.

Risks

• Delayed diagnosis and misdiagnosis due to limited diagnostic resources and lack of standardized reporting.
• Underreporting and incomplete data collection hinder accurate epidemiological understanding.
• Malnutrition may complicate treatment and outcomes.

Patient & Prescribing Data

Children and adolescents under 18 years diagnosed with AML in Uganda

Diagnosis and treatment decisions are often based on clinical and morphological findings due to limited access to advanced diagnostics; nutritional status and CNS involvement are important considerations.

Clinical Best Practices

• Enhance awareness among primary healthcare providers to reduce delayed or missed AML diagnosis.
• Implement standardized AML reporting and data management systems to improve epidemiological data accuracy.
• Utilize available diagnostic tools effectively, including bone marrow morphology and limited flow cytometry.
• Assess and address nutritional status as part of comprehensive patient care.
• Evaluate CNS involvement early to guide treatment planning.

Related Resources & Content

• Global incidence and epidemiology of pediatric AML
• FAB classification criteria for AML diagnosis
• WHO nutritional assessment guidelines
• CNS involvement criteria in AML
• Uganda National Population and Housing Census 2024