Pattern of childhood acute leukemia presentation at a tertiary hospital in Nigeria: a five-year review

Adewumi B. Oyesakin, Vincent E. Nwatah, Nwankwo U. Ukpai, Ekaette I. David, Tamunomieibi T. Wakama, Oluseyi Oniyangi


Background: Acute leukemia is the most common childhood malignancy but its occurrence in low- and middle-income countries are under-reported. Its pattern of presentation varies depending on several factors. The objective of this report is to determine the pattern of presentation of acute leukemias in children at a tertiary hospital in Nigeria.

Methods: A retrospective cross-sectional study of children managed for acute leukemia at the Paediatric Department in a 5-year period. Of 31 patients, 27 had adequate records, which were reviewed. Data collected include patient’s demographics, clinical features and treatment outcome.

Results: There were 16 males and 11 females, aged 8 months to 16 years (mean 7.45 years ±4.75 SD). The pattern of clinical features were fever (85.2%), pallor (92.6%) and splenomegaly (51.9%). The specific leukemia type ratio for Acute Myeloid leukemia (AML) and Acute lymphoblastic leukemia (ALL) was 1: 2.9. The parents of three patients took their children away before commencement of treatment, one patient completed treatment and 6 (22.2%) died before completing treatment. Nearly half of the patients were lost to follow up to seek alternative care while 9 (33.3%) of the patients were in remission at last follow up. Lost to follow-up was found not to be significantly associated with socioeconomic status, age and sex respectively.

Conclusions: Acute lymphoblastic leukemia remains the predominant type of childhood leukemia in our setting. Majority of the patients presented with fever and pallor moreover the default to follow-up plagues treatment completion.


Acute Leukemia, Follow-up, Outcome, Presentation

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Kaatsch P. Epidemiology of childhood cancer. Cancer Treat Rev. 2010;36:277‑85.

Center M, Siegel R, Jemal A. Global cancer facts and figures. Atlanta: American Cancer Society. 2011:1-52.

Howlader N, Noone AM, Krapcho M. SEER Cancer Statistics Review, 1975–2010. National Cancer Institute, Bethesda, Md, USA; 2010.

Smith MA, Ries L, Gurney J, et al. Leukemia. In: Ries L, Smith, M, Gurney J, et al, editors. Cancer Incidence and survival among children and adolescents: United States SEER Program 1975-1995. Bethesda, MD: National Cancer Institute, SEER Program; 1999:17-34.

Eden T. Aetiology of childhood leukaemia. Cancer Treatment Rev. 2010;36(4):286-97.

Babatunde TO, Ogun GO, Brown BJ, Akang EE, Aken'Ova YA. Pattern of childhood leukaemia in University College Hospital, Ibadan. Afr J Med Med Sci. 2014;43(2):135-8.

Puumala SE, Ross JA, Aplenc R, Spector LG. Epidemiology of Childhood Acute Myeloid Leukemia. Pediatr Blood Cancer. 2013;60(5):728-33.

Bashir M, Zaman S, Rafatullah WF, Shoaib M, Biland B. Hematological and clinical presentation of acute leukemias at Khyber Pukhtoonkhwa. Gom J Med Sci. 2010;8:134-40.

Williams CKO, Foroni L, Luzzatto L, Saliu I, Levine A, Greaves MF. Childhood leukaemia and lymphoma: African experience supports a role for environmental factors in leukaemogenesis. Ecancer. 2014;8:478.

Rubnitz JE, Gibson B, Smith FO. Acute myeloid leukemia. Hematol Oncol Clin N Am. 2010(24):35-63.

Hadley LGP, Rouma BS, Saad-Eldin Y. Challenge of pediatric oncology in Africa. Seminars in Pediatric Surg. 2012;21:136-41

Olusanya O, Okpere E, Ezimokhai M. The importance of social class in voluntary fertility control. West Afr J Med. 1985;4:205-12.

Ali AM, Sayed HA, Sayed DM, Mikhail NN. Pattern of pediatric tumors at pediatric department in South Egypt Cancer Institute: thirteen years report. J Pediatr Child Nutr. 2016;2(2):100-12.

Ochicha O, Gwarzo AK, Gwarzo D. Pediatric malignancies in Kano, Northern Nigeria. World J Pediatr. 2012;8(3):235-9.

Fleming AF. Epidemiology of the leukemias in Africa. Leukemia Rese. 1978;3(2):51-9.

Ahmad HR, Faruk JA, Abdullahi M, Olorunkooba AA, Ishaku H, Abdullahi FL, et al. Pattern and outcomes of childhood malignancies at Ahmadu bello university teaching hospital, Zaria. Sub-Saharan Afr J Med. 2016;3:127-31.

Magrath I, Steliarova-Foucher E, Epelman S, Ribeiro RC, Harif M. Paediatric cancer in low-income and middle-income countries. Lancet Oncol. 2013;14:e104-16.

Hossain MJ, Xie L, McCahan SM. Characterization of pediatric acute lymphoblastic leukemia survival patterns by age at diagnosis. J Cancer Epidemiol. 2014;2014.