Introduction The strongest predictor of treatment outcome in patients with retinoblastoma is the national income of their country. Here, we report on ten years of retinoblastoma treatment in a Kenyan tertiary referral and teaching hospital. Methods Children newly diagnosed with retinoblastoma who were treated at the pediatric oncology ward between January 2012 and December 2021 were included in this retrospective record review study. The probability of event-free survival (pEFS) was estimated with the Kaplan-Meier method. Hazard ratios (HR) were calculated to assess the effect of covariates. A competing risk analysis was performed to estimate the probability of progressive disease, relapse, death and abandonment. Results Of the 106 patients whose records were reviewed, 75% presented with stage 4 disease or higher (Reese-Ellsworth classification) and 25% had central nervous system (CNS) metastases. Two-year pEFS was 25.2% (95% CI 0.17–0.38). The reasons for treatment failure were abandonment (n=39), progressive or relapsed disease (n=17) and death (n=9). No health insurance or CNS metastases negatively affected pEFS (HR 3.87, 95% CI 2.29–6.53, p<0.001 and HR 4.76, 95% CI 2.66–8.51, p<0.001 respectively). Patients who received radiotherapy had a borderline significantly higher pEFS than those who were eligible but did not (HR 0.39, 95% CI 0.14-1.08, p=0.06). Conclusion The survival rate of patients diagnosed with retinoblastoma was low. The main challenges were advanced disease at presentation and abandonment. Raising awareness and early referral is key to improve survival. However, as long as patients present with advanced disease, efforts should focus at ensuring that patients complete treatment, including radiotherapy.

The low incidence of vincristine-induced peripheral neuropathy (VIPN) in Kenyan children may result from low vincristine exposure. We performed a pharmacokinetically (PK) guided dose-escalation feasibility study of vincristine in Kenyan children (NCT05844670). Vincristine PK exposure was assessed with a previously developed nomogram. A 20% dose increase was recommended for participants with low exposure and no VIPN, hyperbilirubinemia or malnutrition. None of the fifteen participants developed VIPN. Low vincristine exposure was seen in only one participant: a dose increase was implemented without side-effects. Average vincristine exposure was high. In conclusion, the participants did not develop VIPN despite having high vincristine exposure.

Background: In our earlier published outcomes of children with acute lymphoblastic leukemia (ALL) at Moi Teaching and Referral Hospital in Kenya (MTRH), we showed low event-free survival (EFS) with high induction mortality and abandonment. Based on this observation, the team focused on strategies to reduce both causes of poor outcomes. Intervention: We dropped doxorubicin from induction therapy as the supply of L-asparaginase became reliable, improved social and financial support for insurance coverage and transportation, promptly initiated empirical antibiotics during episodes of febrile neutropenia, and enhanced the availability of blood products. Objective: Our study compared childhood ALL outcomes before (2010-2016) and after (2017-2020) modification of induction therapy, with improved social and financial support and supportive care. Methods: We reviewed the medical records of 123 children with ALL between 2017 to 2020. Their treatment results were collected and compared to those of 136 children before the (2010-2016) modification of induction therapy, with improved social and financial support. Results: Three-year EFS estimates improved from 18.2% to 40.7%. Relapse or progressive disease decreased from 26% to 16%, and abandonment from 24% to 14%. Deaths and survival through induction did not change significantly between the two periods. Children between 1-9 years and those with white blood cell (WBC) count <50x10 9/L had better EFS. Conclusions: Treatment abandonment and relapse decreased, and EFS increased significantly. However, strategies to improve early diagnosis and supportive care are needed to reduce induction mortality. In addition, enhanced parental education and continuous counseling are required to minimize treatment abandonment further.