Long term survival of children with Burkitt lymphoma in Malawi after cyclophosphamide monotherapy

Abstract

Background Between 1991 and 1997, limited funding at times restricted available treatment for children with Burkitt lymphoma (BL) to cyclophosphamide (CPM) monotherapy at Lilongwe Central Hospital, Malawi. Our objective was to assess long‐term survival in Malawian children with Burkitt lymphoma (BL) who had received one or more treatments with intravenous CPM at 40 mg/kg/dose at 14‐day intervals. Procedure and Results The study population consisted of 92 children in whom BL had been confirmed on fine needle aspirates (FNA), a home address had been documented on discharge from hospital, and the treatment records could be verified. Only the clinical site(s) of disease had been recorded. The M:F ratio was 1.4 and median age 8 years. A clinical officer on motorcycle attempted to locate the given addresses and interview parents or other sources. In 19 patients, the address was incorrect. Of 73 evaluable patients, 40 children are alive at a mean follow‐up time of 59 (range: 29–104) months. The survival rate was 63.5% in 52 children with BL of the head only, and 33.3% in 21 children with primary disease involving the abdomen or other sites. Survivors had received a median number of 6 (range: 1–12), non‐survivors 4 (range: 1–12), and untraceable children 3 (range: 1–11) courses of CPM. Conclusions We confirmed that CPM could cure children with facial and abdominal BL. The unavoidable bias in the selection of patients and the variable amount of CPM given, precludes accurate survival estimates. A prospective study with proper staging, assessment of FNA, marrow and cerebrospinal fluid with modern techniques, a standard treatment protocol, and adequate follow‐up will better define the current therapeutic value of CPM monotherapy. CPM can be purchased at about 3 US dollars per 500 mg. Med Pediatr Oncol 2003;40:23–25, © 2003 Wiley‐Liss, Inc.

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

“…We previously recorded an event-free survival rate of 57% in 44 patients with eBL St Jude stages I, II & III with mediumdose-intensity chemotherapy (which was expensive and very toxic), and also recorded significant long-term survival after cyclophosphamide monotherapy. 12,13 The eventfree survival beyond 1 year of almost 50% compares favourably with the overall 29% recorded using more expensive, historical low-intensity combination chemotherapy schedules such as COM (cyclophosphamide, vincristine sulphate, methotrexate) 14 and is comparable with the 48% event-free survival from abdominal disease treated with CVA (cyclophosphamide, vincristine sulphate, arabinoside-C, intrathecal methotrexate). 15 The average cost of the chemotherapy drugs was ,50 US$/patient.…”

Burkitt lymphoma in Papua New Guinea—40 years on

“…31,32 However, cyclophosphamide alone is often used in situations where other drugs are not available and a recent report from Malawi described relatively good outcome using cyclophosphamide at doses of 40 mg/kg at 14-day intervals. 33 In that study, 73 of the 92 patients with a median age of 8 years were followed up and 40 of them were alive at a mean follow-up of 59 months, and there was a survival rate of 63.5% in 50 children with initial involvement of the face. Whilst the authors acknowledge sampling bias, their overall results indicate that cyclophophamide alone might well be an appropriate regimen for patients with low-stage disease.…”

Haematological cancers in African children: progress and challenges

“…The exceptions are in North Africa, where more intense protocols are used (Harif et al, 2008). To try to reduce toxicities and make treatment more affordable, trials were undertaken in Malawi using cyclophosphamide monotherapy in the late 1990s and early 2000s that achieved 63% survival in stages I and II (facial disease) and 33% for other sites (Kazembe et al, 2003). An earlier trial in the 1970s using combination chemotherapy had a 2-year overall survival rate for abdominal disease of 63%, though this excluded early deaths of 26% (Nkrumah et al, 1977).…”