BACKGROUND: Routine leukemia diagnosis is through microscopic identification of pathological blood cells in patients with abnormal Full Blood Count (FBC) scattergrams and severe leucocytosis. Accuracy and timeliness of results is prone to many variables that could lead to incorrect diagnosis. Mozambique has a significant burden of pediatric cancers accounting for significant burden with a high frequency of HIV-associated cancers. Improved diagnostic access and leukemia surveillance are thus needed. Flow cytometry was implemented to improve acute pediatric leukemia differential diagnosis linked with timely treatment initiation. The implementation was to determine the feasibility of flow cytometry in leukemia diagnosis instead of only microscopy.
DESCRIPTION: Instituto Nacional de Saúde (INS) introduced flow cytometry for leukemia differential diagnosis using the BD FacsCanto II equipment in 2020. Clinical and technical trainings on identification of suspected leukemia cases were conducted in 7 of the 11 provinces namely Inhambane, Nampula, Zámbezia, Tete, Cabo Delgado and Sofala. Clinical staff at the regional referral hospitals were trained by the the pediatric oncologist from Maputo and laboratory staff were trained on pathological cells identification and interpretation of FBC scattergrams by biomedical scientists from INS. Suspected pediatric leukemia cases (0 – 14 years) had samples collected at regional hospitals and sent to INS for flow cytometry testing. Results were available to the Oncologist within 24hours of reaching the INS laboratory enabling timely leukemia-type specific treatment of cases.

LESSONS LEARNED: 171 suspected cases were tested from January 2020 to December 2022. 89 patients were male and 82 were female. Of these patients 88 (51.5%) had leukaemia (42 female and 46 male). Two patients with leukaemia (2.27%), were HIV-1 infected. Three years mortality was highest (53%) among children aged 5-10 years. Mortality was highest among acute myeloid leukaemia cases (52%) although B acute lymphoblastic leukaemia was the most common cancer (45%). Other leukemias namely T acute lymphoblastic leukaemia and mixed phenotypes were diagnosed.
CONCLUSIONS: Flow cytometry for leukemia differential diagnosis is feasible in Mozambique enabling linking leukemia-specific cases to specific treatment with potential improved survival. Flow cytometry could revolutionise leukemia diagnosis especially among pediatric HIV patients and is more accurate in leukemia diagnosis compared to microscopy alone.

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