Incidence of Induction Toxicities in Childhood Acute Lymphoblastic Leukaemia in Ghana.

Introduction: Due to limited supportive care, low- and middle-income countries balance delivering intensive, curative chemotherapy with the risk of treatment-related toxicity. Acute lymphoblastic leukaemia (ALL) is the commonest childhood cancer, and induction is the highest risk period for morbidity and mortality. The study describes induction toxicities among children with ALL at Korle Bu Teaching Hospital, Ghana. Methods: This hospital-based cohort study involved children aged 1-17 years newly diagnosed with ALL from August 2021 to January 2023. Demographic, clinical and laboratory data were recorded. Descriptive statistics (median [interquartile range]) were used to summarise continuous variables. Frequency and percentages were used to describe categorical variables. Toxicities were graded using the Common Terminology Criteria for Adverse Events, Version 5.0. Results: Thirty-one children were included. Median age was 5 years (interquartile range [IQR]: 3-10 years). All 31 had at least one induction toxicity of any grade, and 29 (93.4%) had at least one severe (Grade ≥ 3). The most common toxicities were anaemia, thrombocytopenia, sepsis, febrile neutropenia, mucositis and hypertension; bleeding, acute pancreatitis, seizures and hepatotoxicity were less common. Induction mortality rate was 19.3%. There was no association found between age, sex, initial white cell count, treatment protocol and development of any severe toxicity. Conclusion: Severe induction toxicities were common in our cohort with unacceptably high mortality, underscoring the need to prioritise enhanced bedside clinical monitoring for hypertension, improved access to blood products and optimal infection prevention and control practices. Further research exploring the relationship between induction toxicities and patient outcomes is essential.