PS1062 PEDIATRIC ACUTE MYELOID LEUKEMIA (AML) IN DEVELOPING COUNTRIES, BARRIERS AGAINST BETTER OUTCOME 10 YEARS’ EXPERIENCE AMONG EGYPTIAN PEDIATRIC ACUTE MYELOID LEUKEMIA

Background: Pediatric AML outcome improved significantly with current survival rates of 70% in developed countries. The outcome of childhood AML in developing countries still lacking. Aims: The aim of the study to assess the causes of mortality and survival outcomes among pediatric AML patients in countries with limited resources. Methods: Retrospective analysis of 344 pediatric AML (2007 ‐ 2016) treated at National Cancer Institute, Egypt including 3 phases protocols with different aims and hypothesis. Results: From 2007–2010, Less intensified induction chemotherapy without antimicrobial prophylaxis ,103 patients enrolled, Complete remission (CR) post induction 1(55%), Refractory disease (34%) and induction mortality (11%). End of study; Relapse 40 %. Mortality 63 patients (61%):(42%) disease‐related (DRM), (42%) infection related (IRM) and (14%) toxicity related (TRM). 70% had fungal infections. 2 years DFS 27% and OS 30%. From 2011‐ 2013, Hypothesis was Antimicrobial prophylaxis can help for a better outcome, 136 patients enrolled used less intensified induction but with levofloxacin and voriconazole prophylaxis. CR rate induction 1 was 75%, refractory disease (17%) and induction mortality was 8%. End of study : Relapse 16%. Mortality in 86(63%) patients: 57 % IRM mostly multidrug resistance (MDR) gram‐negative bacteremia while DRM 33%. 10% had fungal infections but still poor 3y DFS (34%) and OS (37%). From 2014–2016, Hypothesis was intensified induction chemotherapy with antimicrobial prophylaxis can be a better solution; 105 patients enrolled, Post induction1, CR 48%, refractory disease 8% and induction mortality 44%. End of study; Relapse rate 6%, Mortality 88(80%) patients: IRM was 72% with MDR gram‐negative bacteremia was the main cause of deaths (62%), DRM 4% and TRM 4% with poor 2y DFS 34% and OS 24%. Summary/Conclusion: A significant gap in the outcomes of pediatric AML as compared to those reported developed countries. The balance between treatment intensification and toxicity are needed. Infections are the major barrier against better outcome needs more strict guidelines protocols.