July 25, 2008

Shortage of cancer drugs impacts Iraqi children with leukemia

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Vanderbilt is studying a new therapy to prevent enlargement of the aorta in patients with Marfan syndrome, like Sam Davis, above, with his mother, Cheryl. (photo by Neil Brake)

Shortage of cancer drugs impacts Iraqi children with leukemia

A study led by Vanderbilt-Ingram Cancer Center researchers revealed that some Iraqi children diagnosed with leukemia paid a steep price for economic sanctions imposed by the United Nations against the Iraqi government.

The U.N.-ordered sanctions were imposed in 1990 after the invasion of Kuwait and remained in effect until 2003, and during that time, there was a widespread shortage of medications.

“We wanted to determine if the reduction in the availability of chemotherapeutic agents resulted in actual changes in health outcomes for Iraqi children diagnosed with acute lymphocytic leukemia,” said Haydar Frangoul, M.D., director of the Pediatric Stem Cell Transplant Program at Vanderbilt-Ingram.

Frangoul and colleagues from the Baghdad Medical College studied the medical records of 651 children diagnosed with acute lymphocytic leukemia (ALL) who were treated at the Children's Welfare Teaching Hospital in Baghdad.

The proportion of patients receiving less than 50 percent of their prescribed chemotherapy due to shortage increased from 20.1 percent in 1990 and 1994 to 54.3 percent between 2000 and 2002. They discovered that the overall survival rate was significantly higher for patients who received all of the prescribed chemotherapy (80 percent versus 55 percent, respectively). The difference in survival rates was significant whether the patients were considered to be in a standard-risk group or a high-risk group.

Relapse was the most common cause of treatment failure, occurring in 217 of the 651 patients.

“There was a significant inverse relationship between the amount of prescribed chemotherapy that was administered and the risk of relapse, i.e., the more prescribed chemotherapy received, the lower the risk of relapse” Frangoul said.

“Our findings reinforce the concept that the most important factor in improving survival even in children with leukemia is providing them with adequate supply of medications and not with expensive diagnostic equipment,” Frangoul said.

The findings were published in the July 24 issue of the New England Journal of Medicine. Contributors included Mazin F. Al-Jadiry, M.D., and Salma A. Al-Hadad, M.D., of Baghdad Medical College; and Vanderbilt's Yu Shyr, Ph.D., Fei Ye, Ph.D., and Bashar Shakhtour, M.S.