Endemic Burkitt lymphoma: a 28-day treatment schedule with cyclophosphamide and intrathecal methotrexate

Hesseling, Peter; Molyneux, Elizabeth; Kamiza, Steve; Israëls, Trijn; Broadhead, Robin L.

doi:10.1179/146532809x402006

Cited by 60 publications

(68 citation statements)

References 13 publications

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“…A pathology report is required before the onset of consolidation chemotherapy to enable proper staging and risk group allocation. This may not be available at all treatment centers [20].…”

Section: Discussionmentioning

confidence: 99%

The Cameroon 2008 Burkitt Lymphoma Protocol: Improved Event-Free Survival with Treatment Adapted to Disease Stage and the Response to Induction Therapy

Hesseling

Kouya

et al. 2012

Pediatric Hematology and Oncology

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Treatment of endemic Burkitt lymphoma (BL) with cyclophosphamide (CPM) and intrathecal methotrexate (IT MTX) can cure 50% of patients. In this study, induction therapy with CPM and IT MTX was followed by consolidation chemotherapy adapted for stage, clinical response, and abdominal ultrasound findings. One hundred and twenty-nine consecutive patients with BL, 77 male and 52 female with a median age of 7.9 years, were treated in mission hospitals in Cameroon. The diagnosis rested on fine-needle aspirate (79%), biopsy, bone marrow, cerebrospinal fluid, abdominal ultrasound, and clinical examination. Six percent had St Jude stage I, 13% stage II, 72% stage III, and 12% stage IV disease. The abdomen (76%) and face (50%) were mainly involved. Induction chemotherapy was CPM 40 mg/kg and IT MTX 12.5 mg and IT hydrocortisone 12.5 mg on days 1, 8, and 15. Stage I and II patients received CPM 60 mg/kg on day 29, and stage III patients CPM 60 mg/kg on days 29 and 43 if in remission on day 28. Stage IV patients and patients not in remission received CPM 60 mg/kg on days 29, 43, and 57 and 1.0 g/m(2) MTX intravenous (IV) and vincristine 1.5 mg/m(2) IV on day 29. Event-free survival (EFS) at mean 365 days was 61% (n = 79) and 100% in stage I, 85% in stage II, 60% in stage III, and 27% in stage IV patients. Deaths (n = 24) were disease or treatment related and 26 patients relapsed (mean 135 days). Risk-adapted treatment achieved 61% 1-year EFS.

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“…A pathology report is required before the onset of consolidation chemotherapy to enable proper staging and risk group allocation. This may not be available at all treatment centers [20].…”

Section: Discussionmentioning

confidence: 99%

The Cameroon 2008 Burkitt Lymphoma Protocol: Improved Event-Free Survival with Treatment Adapted to Disease Stage and the Response to Induction Therapy

Hesseling

Kouya

et al. 2012

Pediatric Hematology and Oncology

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“…4 Although chemotherapy regimens for aggressive B-cell lymphomas in Malawi do not mirror HIC protocols, in part due to a lack of sufficient supportive care, BL and non-BL aggressive NHL are nonetheless differentially treated in Malawi, and therefore, accurate segregation of these diagnoses is immediately relevant. 10,11 Unsupervised hierarchical clustering using a 21-gene NanoString-based classifier previously only applied to Western cohorts 17 had a diagnostic accuracy for DLBCL and BL of 96% and 88%, respectively, in our cohort. The significant advantage of this approach is the ability to perform targeted profiling on FFPE with relatively straightforward sample preparation.…”

Section: Discussionmentioning

confidence: 99%

“…10 High-intensity regimens for BL provided in HICs cannot be given in Malawi because of both the high cost and unacceptable treatment-associated mortality. 11 Targeted therapies for NHL that are standard of care in HICs, most notably the anti-CD20 antibody rituximab, have historically been unavailable in countries like Malawi. 12 In contrast, several targeted agents with potent activity against specific subsets of NHL and reduced toxicity compared with CHOP are either in clinical trials or recently approved in HICs.…”

Section: Introductionmentioning

confidence: 99%

Targetable subsets of non-Hodgkin lymphoma in Malawi define therapeutic opportunities

et al. 2016

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“…The cases of ALL in Brazil and BL in Malawi were chosen as two examples since cost and outcome data were available in these two cases 25 26. Several factors make the decision to focus on these cancers a useful exercise.…”

Section: Methodsmentioning

confidence: 99%

“…Potential late effects of treatment such as second malignancies, cardiac and respiratory dysfunction, infertility and neurocognitive delays were also excluded from the model because they are uncommon in children with ALL and BL treated in HIC and their effect on the model would be negligible 21 27 28. It is worth noting that cranial irradiation was not used in the Brazilian study of children with ALL, thereby excluding a potentially significant cause of late effects 25 26…”

Section: Methodsmentioning

confidence: 99%

The cost effectiveness of treating paediatric cancer in low-income and middle-income countries: a case-study approach using acute lymphocytic leukaemia in Brazil and Burkitt lymphoma in Malawi

Bhakta

Martiniuk

Gupta

et al. 2012

Archives of Disease in Childhood

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Approximately 90% of children with cancer reside in low-income and middle-income countries (LMIC) where healthcare resources are scarce and allocation decisions difficult. The cost effectiveness of treating childhood cancers in these settings is unknown. The objective of the present work was to determine cost-effectiveness thresholds for common paediatric cancers using acute lymphoblastic leukaemia (ALL) in Brazil and Burkitt lymphoma (BL) in Malawi as examples. Disability-adjusted life years (DALYs) prevented by treatment were compared to the gross domestic product (GDP) per capita of each country to define cost-effectiveness thresholds using WHO-CHOICE ('CHOosing Interventions that are Cost-Effective') guidelines. The case examples were selected due to the data available and because ALL and BL both have the potential to yield significant health gains at a low cost per patient treated. The key findings were as follows: the 3:1 cost/DALY prevented to GDP/capita ratio for ALL in Brazil was US $771,225; expenditures below this threshold were cost effective. Costs below US $257,075 (1:1 ratio) were considered very cost effective. Analogous thresholds for BL in Malawi were US $42,729 and US $14,243. Actual costs were far less. In Brazil, US $16,700 was spent to treat each patient while in Malawi total drug costs were less than US $50 per child. In summary, treatment of certain paediatric cancers in LMIC is very cost effective. Future research should evaluate actual treatment and infrastructure expenditures to help guide policymakers.

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Endemic Burkitt lymphoma: a 28-day treatment schedule with cyclophosphamide and intrathecal methotrexate

Abstract: This short, inexpensive treatment schedule (<50 US$) cured almost 50% of eBL patients in a setting of very limited resources.

Cited by 60 publications

References 13 publications

The Cameroon 2008 Burkitt Lymphoma Protocol: Improved Event-Free Survival with Treatment Adapted to Disease Stage and the Response to Induction Therapy

The Cameroon 2008 Burkitt Lymphoma Protocol: Improved Event-Free Survival with Treatment Adapted to Disease Stage and the Response to Induction Therapy

Targetable subsets of non-Hodgkin lymphoma in Malawi define therapeutic opportunities

The cost effectiveness of treating paediatric cancer in low-income and middle-income countries: a case-study approach using acute lymphocytic leukaemia in Brazil and Burkitt lymphoma in Malawi

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