Abstract

Objective

 To characterise the structure and dynamics of childhood acute leukaemia incidence in Tajikistan using updated data for 2020–2025, and to identify independent predictors of diagnostic delay that inform practical approaches to early diagnosis and complication prevention. 
 

Materials and Methods

A retrospective descriptive study of leukemia cases in children under 14 years for 2020–2025 based on official medical statistics, supplemented by a prospective cohort study of 50 children under 14 years with newly diagnosed acute leukemia and no prior chemotherapy, to identify predictors of diagnostic delay using multivariable regression analysis with calculation of relative risk (RR) and 95% confidence intervals (CI). 

Results

Peak incidence was recorded in 2023 (89 cases); acute forms accounted for 82.4%. Independent predictors of delay were: absence of a haematology analyser at the first point of contact (RR 3.8; 95% CI 2.5–5.4), no complete blood count at initial assessment (RR 3.2; 95% CI 2.1–4.9), initial presentation to primary healthcare rather than direct specialist referral (RR 2.8; 95% CI 1.9–4.1), and rural residence (RR 2.1; 95% CI 1.4–3.2). 
 

Conclusion

A three-step early detection algorithm and a comprehensive complication-prevention protocol are proposed. Implementation requires strengthening primary-care laboratory infrastructure and establishing a national paediatric leukaemia registry.
 

Keywords

acute leukemia children Tajikistan COVID-19 early diagnosis diagnostic delay complication prevention.

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References

  1. Lü M, Pan Y, Xu J, et al. Global incidence of childhood cancer by subtype in 2022: a population-based registry study. E ClinicalMedicine. 2025;82:103157. doi: 10.1016/j.eclinm.2025.103157.
  2. Erdmann F, Spix C, Schrappe M, Borkhardt A, Schüz J. Temporal changes of the incidence of childhood cancer in Germany during the COVID-19 pandemic: Updated analyses from the German Childhood Cancer Registry. Lancet Reg Health Eur. 2022;17:100398. doi: 10.1016/j.lanepe.2022.100398.
  3. Borkhardt A, Schüz J, Trübenbach C, et al. Temporal changes of the incidence of childhood B-cell precursor acute lymphoblastic leukaemia in Germany during the COVID-19 pandemic. Leukemia. 2022;36(12):2908-2911. doi: 10.1038/s41375-022-01730-x.
  4. Wang Y, Xu J, Liu J, et al. Global burden of acute lymphoblastic leukemia following the COVID-19 pandemic. Ann Hematol. 2025. doi: 10.1007/s00277-025-06639-w.
  5. Greaves M. COVID-19 and childhood acute lymphoblastic leukemia. Pediatr Blood Cancer. 2020;67(12):e28481. doi: 10.1002/pbc.28481.
  6. Greaves M. A causal mechanism for childhood acute lymphoblastic leukaemia. Nat Rev Cancer. 2018;18(8):471-484. doi: 10.1038/s41568-018-0015-6.
  7. Leclercq C, Toutain F, Baleydier F, et al. Pediatric acute B-cell lymphoblastic leukemia developing following recent SARS-CoV-2 infection. Pediatr Blood Cancer. 2022;69(4):e29514. doi: 10.1002/pbc.29514.
  8. Teng C, Zheng R, He X, et al. Global patterns of leukemia by subtype, age, and sex in 185 countries in 2022. Leukemia. 2024. doi: 10.1038/s41375-024-02452-y.
  9. Khodjaeva NN, Sodikov NM. Osobennosti epidemiologii leykozov u detey v Tadzhikistane v period 2020-2024 gg. [Features of the epidemiology of leukemia in children in Tajikistan in 2020-2024]. Vestnik poslediplomnogo obrazovaniya v sfere zdravookhraneniya [Herald of the Institute of postgraduate education in health sphere]. 2025;(1):42-48. (In Russ.)
  10. Khoury JD, Solary E, Abla O, et al. The 5th edition of the World Health Organization Classification of Haematolymphoid Tumours: myeloid and histiocytic/dendritic neoplasms. Leukemia. 2022;36(7):1703-1719. doi: 10.1038/s41375-022-01613-1.
  11. Malard F, Mohty M. Acute lymphoblastic leukaemia. Lancet. 2020;395(10230):1146-1162. doi: 10.1016/S0140-6736(19)33018-1.
  12. Lehrnbecher T, Groll AH, Cesaro S, et al. Invasive fungal diseases impact on outcome of childhood ALL: an analysis of the international trial AIEOP-BFM ALL 2009. Leukemia. 2023;37(2):357-365. doi: 10.1038/s41375-022-01768-x.