Acute lymphoblastic leukaemia (ALL) is a potentially curable haematologic cancer with variable prognosis and response to therapy. In most populations, over 70% of cases occur in children and adolescents, the remaining 30-40% in adults. In the Caucasian populations, durable remission has been achieved in over 80% of children with standard-risk (SR) disease. Early studies on standard ALL therapy at the St Jude Children’s Hospital, USA, confirmed very poor survival of black children compared to white children, with a 5-year survival (±SE) of 34±4 % and 57 ±1% (p = 0.001), respectively. Williams, et al published a similar poor survival among Nigerian children compared to Western Caucasian children in 1982 (Williams, et al. Br J Cancer 1982; 46:89). Later studies by the American group using risk-directed therapy and with equal access to effective treatment, confirmed very good treatment outcome for both black and white children, despite the higher incidence of high-risk disease in black children, with 5-year event-free and overall survival rates of over 80% for both groups, 10-year survival results were comparable. (Pui CH, et al. JAMA1995;273:633; Pui CH, et al. JAMA 2003; 290:2001). Nigerian and a large majority of sub-Saharan African ALL patients have HR diseases resulting from unfavorable disease biology, unhealthy lifestyles, hostile environmental conditions, hyperleukocytosis, Ph/BCR-ABL1+ disease, cALL negative ALL, T-cell ALL, age <2 or >7 years at presentation, poor response to 7-day prephase prednisolone therapy, etc. But for I-asparaginase and Neupogen that were not readily available in my residency days some four decades ago, treatment of ALL in Nigeria at UCH, Ibadan has been consistent with global best practices, with availability of standard cytotoxic drugs corticosteroid, vincristine, adriamycin, methotrexate, cyclophosphamide, cytarabine and 6-mercaptopurine in various combinations for induction, early intensification and maintenance.
AORTICHORG would like to conduct a clinical trial in this indication (in patients age 1-30) adapting the MCP841 Protocol that has been used for over 20 years in India and deploying the BRM90 regimen which is more suitable for the predominantly high-risk patients seen in our setting, with 4 induction phases, followed by consolidation and a prolonged maintenance phase, making it more aggressive than the standard risk protocol. We anticipate that this protocol will have an acceptable toxicity profile for our patients and will be cost-effective, taking advantage on cancer medicines that are included in the WHO model essential medicines list of cancer.
