Outcome is unchanged by adding vincristine upfront to the Malawi 28‐day protocol for endemic Burkitt lymphoma

Abstract

The addition of vincristine to the Malawi 28 day BL treatment protocol did not improve survival.

Optimizing outcomes for children with non‐Hodgkin lymphoma in low‐ and middle‐income countries by early correct diagnosis, reducing toxic death and preventing abandonment

“…Treatment duration is short, and most patients complete treatment after 4 or 6 blocks given every 2–3 weeks. However, implementing this intensive strategy involves overcoming many challenges at each step, and in many low‐income countries (LIC) it is simply not feasible, and lower dose regimens are the only alternative (Depani et al , ; Buckle et al , ; Stanley et al , ). Although such regimens yield EFS lower than the 90% achieved in HIC, they allow a subset of patients to be cured without excess toxicity and are feasible even in the most basic healthcare systems (Howard et al , ,b, , ).…”

The use of anthracyclines in the treatment of endemic Burkitt lymphoma

“…Sporadic BL in resource‐rich countries has a disease‐free survival (DFS) greater than 90% even in advanced stage disease (Patte et al , ; Gerrard et al , ) but this requires very intensive chemotherapy, which is neither feasible nor safe in most low‐income countries. As a result, countries, such as Malawi, which have previously tried simplified versions of the LMB protocols (B cell Non Hodgkin Lymphoma and B Acute Lymphoblastic Leukaemia schedules from the Société Française d'Oncologie Pédiatrique) with unacceptable toxicity, have developed protocols appropriate to their setting, both in terms of length of treatment and intensity (Hesseling et al , , ; Depani et al , ). The modified LMB 89 protocol was a 77‐day regimen with reduced doses of methotrexate (2 vs. 3 g/m 2 ), vincristine, 1·5 mg/m 2 vs. 2 mg/m 2; adriamycin and etoposide were not included.…”

“…Using a range of protocols between 1997 and 2010 with a duration between 28 and 57 days, the DFS was approximately 50% for all stages but with an average event‐free survival of approximately 30% for stage III and IV disease (Table ) (Hesseling et al , , , , ; Depani et al , ). The rescue rate at relapse has remained around 30% over this time (Hesseling et al , ).…”

“…With this experience and the desire to improve the outcome of higher stage BL without an increase in the duration of stay for the families, doxorubicin at a total dose of 120 mg/m 2 was added to the previous protocol that was developed in 2010 (Depani et al , ) and administered during week two and four of the treatment protocol. This dose was thought to offer potential benefits with minimal risk of cardiotoxicity and is used in the majority of children at similar doses for the treatment of non‐haematopoietic tumours.…”

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

“…However, in low-resource settings in SSA, there is no accepted standard for BL treatment. Cure rates using low-and medium-intensity chemotherapy in SSA are substantially lower, with event-free survival (EFS) or overall survival (OS) ranging between 25% and 62% [Depani et al (2015); Hesseling et al (2009Hesseling et al ( , 2006; Kazembe et al (2003); Ngoma et al (2012); Nkrumah and Perkins (1976); Olweny et al (1980)]. More intensive protocols incorporating high-dose methotrexate have often resulted in excessive treatment-related mortality given the supportive care limitations in this region [Harif et al (2008); Hesseling et al (2005Hesseling et al ( , 2003Hesseling et al ( , 2012; Stefan and Lutchman (2014); Traore et al (2011)].…”