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

Abstract

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.

Pediatric Non-Hodgkin Lymphomas: First Report from Central Africa

“…In Central Africa, there is anecdotal information on NHL in pediatric population [12]. Our study is the first to look at the outcome and the limitations to management of NHL in the DRC.…”

Meeting the challenge of hematologic malignancies in sub-Saharan Africa

“…88 Acceptable results were achieved in North Africa, whereas in sub-Saharan Africa, the balance of efficacy and toxicity led to eventual replacement of more intensive protocols with single-agent cyclophosphamide and intrathecal methotrexate, a regimen that results in a 50% cure rate at a cost of less than $50 (US) per child, with more intensive regimens reserved for advanced, relapsed, and refractory cases. 89,90 Efforts are ongoing to develop similar locally adapted pediatric protocols for acute lymphocytic leukemia, HL, retinoblastoma, and brain tumors. 91,92 The adult oncology community has been slower to develop such collaborations.…”

Celebrating treatment completion in sub-Saharan Africa

“…Despite much effort-which include patient-centred counselling, 2 fee coverage, 3 attentiveness to nutritional status, 4 social support, 5 infrastructure develop ments, 6 gradual adaptation of treatment regimens with decreased toxicity, 7,8 and collabor ative partnerships 9 -the rates of treatment completion remain low, with reported abandonment rates of 40-50%. [10][11][12][13] I recently visited a twinning site in sub-Saharan Africa on the day of a patient's treatment completion.…”