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. 2016 Jun;173(5):705-12.
doi: 10.1111/bjh.13986. Epub 2016 Feb 23.

Outcomes for paediatric Burkitt lymphoma treated with anthracycline-based therapy in Malawi

Christopher C Stanley  1 , Kate D Westmoreland  1 , Brett J Heimlich  1 , Nader K El-Mallawany  2 , Peter Wasswa  3 , Idah Mtete  4 , Mercy Butia  4 , Salama Itimu  1 , Mary Chasela  4 , Mary Mtunda  4 , Mary Chikasema  1 , Victor Makwakwa  1 , Bongani Kaimila  1 , Edwards Kasonkanji  1 , Fred Chimzimu  1 , Coxcilly Kampani  1 , Bal M Dhungel  1 , Robert Krysiak  1 , Nathan D Montgomery  5 , Yuri Fedoriw  5 , Nora E Rosenberg  1   5 , N George Liomba  1 , Satish Gopal  1   5   6
Affiliations

Outcomes for paediatric Burkitt lymphoma treated with anthracycline-based therapy in Malawi

Christopher C Stanley et al. Br J Haematol. 2016 Jun.

Abstract

Burkitt lymphoma (BL) is the most common paediatric cancer in sub-Saharan Africa (SSA). Anthracyline-based treatment is standard in resource-rich settings, but has not been described in SSA. Children ≤18 years of age with newly diagnosed BL were prospectively enrolled from June 2013 to May 2015 in Malawi. Staging and supportive care were standardized, as was treatment with CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) for six cycles. Among 73 children with BL, median age was 9·2 years (interquartile range 7·7-11·8), 48 (66%) were male and two were positive for human immunodeficiency virus. Twelve (16%) had stage I/II disease, 36 (49%) stage III and 25 (34%) stage IV. Grade 3/4 neutropenia occurred in 17 (25%), and grade 3/4 anaemia in 29 (42%) of 69 evaluable children. Eighteen-month overall survival was 29% (95% confidence interval [CI] 18-41%) overall. Mortality was associated with age >9 years [hazard ratio [HR] 2·13, 95% CI 1·15-3·94], female gender (HR 2·12, 95% CI 1·12-4·03), stage (HR 1·52 per unit, 95% CI 1·07-2·17), lactate dehydrogenase (HR 1·03 per 100 iu/l, 95% CI 1·01-1·05), albumin (HR 0·96 per g/l, 95% CI 0·93-0·99) and performance status (HR 0·78 per 10-point increase, 95% CI 0·69-0·89). CHOP did not improve outcomes in paediatric BL compared to less intensive regimens in Malawi.

Keywords: Burkitt lymphoma; Epstein-Barr virus; Malawi; paediatric cancer; sub-Saharan Africa.

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Conflict of interest statement

Conflict of interest: The authors declare no competing financial interests.

Figures

Figure 1
Figure 1. Peripheral blood counts with interquartile ranges among CHOP-treated children with Burkitt lymphoma in Lilongwe, Malawi
Chemotherapy was initiated with COP pre-phase [cyclophosphamide 300–400 mg/m2 on day 1, vincristine 1 mg/m2 (maximum 2 mg) on day 1, and prednisone 1.5 mg/kg/day on days 1–5]. CHOP was started seven days later for a total of six cycles administered every 21 days as tolerated. WBC, white blood cells
Figure 2
Figure 2. Kaplan-Meier overall survival estimates among CHOP-treated children with Burkitt lymphoma in Lilongwe, Malawi
(A) Overall cohort with 95% confidence intervals. (B) Stratified by age. (C) Stratified by gender. (D) Stratified by lactate dehydrogenase. (E) Stratified by clinical stage. (F) Stratified by Lansky performance status.
See this image and copyright information in PMC

References

    1. Adde M, Shad A, Venzon D, Arndt C, Gootenberg J, Neely J, Nieder M, Owen W, Seibel N, Wilson W, Horak ID, Magrath I. Additional chemotherapy agents improve treatment outcome for children and adults with advanced B-cell lymphomas. Semin Oncol. 1998;25:33–39. discussion 45–38. - PubMed
    1. Brinkhof MW, Spycher BD, Yiannoutsos C, Weigel R, Wood R, Messou E, Boulle A, Egger M, Sterne JA. Adjusting mortality for loss to follow-up: analysis of five ART programmes in sub-Saharan Africa. PLoS One. 2010;5:e14149. - PMC - PubMed
    1. Burkhardt B, Zimmermann M, Oschlies I, Niggli F, Mann G, Parwaresch R, Riehm H, Schrappe M, Reiter A. The impact of age and gender on biology, clinical features and treatment outcome of non-Hodgkin lymphoma in childhood and adolescence. Br J Haematol. 2005;131:39–49. - PubMed
    1. Burkhardt B, Oschlies I, Klapper W, Zimmermann M, Woessmann W, Meinhardt A, Landmann E, Attarbaschi A, Niggli F, Schrappe M, Reiter A. Non-Hodgkin’s lymphoma in adolescents: experiences in 378 adolescent NHL patients treated according to pediatric NHL-BFM protocols. Leukemia. 2011;25:153–160. - PubMed
    1. de Witt P, Maartens DJ, Uldrick TS, Sissolak G. Treatment outcomes in AIDS-related diffuse large B-cell lymphoma in the setting roll out of combination antiretroviral therapy in South Africa. J Acquir Immune Defic Syndr. 2013;64:66–73. - PMC - PubMed

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