The changing clinical pattern of endemic Burkitt lymphoma in Western Africa: Experience from a tertiary center in Ghana

Offor, Ugonna T.; Akyea, Ralph Kwame; Neequaye, Janet; Renner, Lorna; Segbefia, Catherine

doi:10.1002/pbc.27275

Cited by 9 publications

(4 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…eBL presents extranodally, frequently in the jaw in younger children and abdominally in older children ( 10 ). Recent studies indicate a changing pattern of presentation with less tumors occurring in the jaw than historically reported ( 11 ). EBV is detected in ~95% of cases ( 12 , 13 ).…”

Section: Epidemiology Of Blmentioning

confidence: 96%

Reframing Burkitt lymphoma: virology not epidemiology defines clinical variants

Rochford¹

2021

Ann Lymphoma

View full text Add to dashboard Cite

In 1964, Epstein-Barr virus (EBV) was identified in a biopsy from a patient with Burkitt lymphoma (BL) launching a new field of study into this ubiquitous human virus. Almost 60 years later, insights into the role of EBV in lymphomagenesis are still emerging. While all BL carry the hallmark c-myc translocation, the epidemiologic classification of BL (e.g., endemic, sporadic or immunodeficiency-associated) has traditionally been used to define BL clinical variants. However, recent studies using molecular methods to characterize the transcriptional and genetic landscape of BL have identified several unique features are observed that distinguish EBV+ BL including a high level of activation induced deaminase mutation load, evidence of antigen selection in the B cell receptor, and a decreased mutation frequency of TCF3/ID3, all found predominantly in EBV+ compared to EBV− BL. In this review, the focus will be on summarizing recent studies that have done in depth characterization of genetic and transcriptional profiles of BL, describing the differences and similarities of EBV+ and EBV− BL, and what they reveal about the etiology of BL. The new studies put forth a compelling argument that the association with EBV should be the defining etiologic feature of clinical variants of BL. This reframing of BL has important implications for therapeutic interventions for BL that distinguish the EBV+ from the EBV− lymphomas.

show abstract

Section: Epidemiology Of Blmentioning

confidence: 96%

Reframing Burkitt lymphoma: virology not epidemiology defines clinical variants

Rochford¹

2021

Ann Lymphoma

View full text Add to dashboard Cite

show abstract

“…26,38,40,41,[48][49][50] This is particularly relevant because numerous studies in SSA have demonstrated that abdominal mass has become at least as common as jaw mass as a presenting feature of endemic BL (Figure 1). 17,20,51,52 A recent clinical quality improvement project at the Uganda Cancer Institute is emblematic of the lack of progress in improving outcomes: over a 5-year period (2012-2017), 180 children with pathology-confirmed diagnoses of BL were treated with COM, with resources dedicated to ensuring accurate diagnosis, chemotherapy availability, and treatment compliance. 44 Despite mitigating limitations of access to care, the 4-year OS was 44%, 44 similar to results from clinical trials at the same center from the 1970s.…”

Section: Contemporary Standards and Efforts To Improve Bl Treatment Imentioning

confidence: 99%

Five decades of low intensity and low survival: adapting intensified regimens to cure pediatric Burkitt lymphoma in Africa

et al. 2020

View full text Add to dashboard Cite

Long-term cure of childhood Burkitt lymphoma (BL) in sub-Saharan Africa after treatment with single-agent cyclophosphamide has been documented for more than half of a century. Contemporary cure rates for the highest-risk patients with BL in high-income countries exceed 90% using intensive multiagent chemotherapy. By contrast, the majority of African children with BL still die. Data spanning 5 decades in Africa have repeatedly shown that the children most likely to achieve cure with limited cyclophosphamide regimens are those with lower-stage disease isolated to the jaw. Attempts to intensify the cyclophosphamide monotherapy backbone with the addition of vincristine, low-dose methotrexate, prednisone, doxorubicin, and/or low-dose cytarabine have not yielded significant improvement. High-dose methotrexate is a critical component in the treatment of childhood BL worldwide. Although initial efforts in Africa to incorporate high-dose methotrexate resulted in high treatment-related mortality, more recent collaborative experiences from North and West Africa, as well as Central America, demonstrate that it can be administered safely and effectively, despite limitations in supportive care resources. Recognizing the unacceptable disparity in curative outcomes for BL between the United States/Europe and equatorial Africa, there is a critical need to safely adapt contemporary treatment regimens to optimize curative outcomes amid the resource limitations in regions where BL is endemic. Here, we critically review reports of BL treatment outcomes from low- and middle-income countries, in addition to data from high-income countries that predated modern intensified regimens, to identify potential strategies to improve the therapeutic approach for children suffering from BL in sub-Saharan Africa.

show abstract

“…Many children in low-and middle-income countries (LMICs) do not have adequate access to cancer services, for example in Ghana, paediatric oncology is mainly offered at four healthcare facilities (11), serving a population of approximately 15 million children. The costs of accessing cancer care in Ghana have been shown to be high (9,12) This together with limited knowledge of childhood cancer in the general population, leads to delays in seeking treatment, which negatively affects survival even after treatment is received (13)(14)(15).…”

Section: Introductionmentioning

confidence: 99%

“…Abandonment, or incomplete treatment, is known to be an important problem in treatment centers (16)(17)(18)(19)(20). More than 50% of children in care are likely to abandon treatment (13). The premature treatment abandonment of childhood cancers in LMICs has been attributed to nancial unaffordability (14)..…”

Section: Introductionmentioning

confidence: 99%

Cost-effectiveness and budget impact of covering Burkitt’s Lymphoma in children under Ghana’s National Health Insurance Scheme

Owusu,

Pritchard,

Heupink

et al. 2023

Preprint

View full text Add to dashboard Cite

Background Many children in sub-Saharan Africa die from preventable deaths due to Burkitt’s lymphoma (BL), an aggressive but highly curable form of non-Hodgkin’s lymphoma. Delayed care seeking and treatment abandonment are common reasons for a relatively low overall survival (OS) in low-and middle-income countries when compared to OS in high income settings. The financial burden of care seeking to families is often the main reason for the high treatment abandonment. Yet childhood cancer is not a high priority in health care financing for many countries, including in Ghana, where at the time of this study, treatment was not covered by the National Health Insurance Scheme (NHIS). In this study, we analyze the cost-effectiveness of extending health insurance coverage to children with BL in Ghana. Methods We developed a Markov model in Microsoft Excel to estimate the costs and effects of BL treatment when NHIS was provided compared to the status quo where NHIS does not cover care for childhood cancer. The analysis was undertaken from the societal perspective. Both costs (measured in $) and effects, measured using disability adjusted life years (DALYs), were discounted at a rate of 3%. The time horizon was a lifetime. Probabilistic sensitivity analysis was done to assess uncertainty in the measurement of the incremental cost-effectiveness ratio (ICER). A budget impact analysis was undertaken from the perspective of the NHIS. Results In the base-case analysis, the intervention (NHIS reimbursed treatment) was less costly than current practice ($8,302 vs $9,558). The intervention was also more effective with less DALYs per patient than the standard of care (17.6 vs 23.33). The ICER was $219 and indicates that intervention is still cost-effective when taking a narrower, health system only perspective. The probabilistic sensitivity analysis showed that the intervention is likely to be both less costly and more effective than current practice in 100% of the 1,000 simulations undertaken. Conclusion Providing health insurance coverage to children with BL is potentially highly cost-effective. The effectiveness and cost-savings relating to this strategy is driven by its positive impact on treatment initiation and retention. Based on this evidence, there has been a policy change where Ghana’s NHIS has prioritized financing for cancer treatment in children.

show abstract

The changing clinical pattern of endemic Burkitt lymphoma in Western Africa: Experience from a tertiary center in Ghana

Cited by 9 publications

References 29 publications

Reframing Burkitt lymphoma: virology not epidemiology defines clinical variants

Reframing Burkitt lymphoma: virology not epidemiology defines clinical variants

Five decades of low intensity and low survival: adapting intensified regimens to cure pediatric Burkitt lymphoma in Africa

Cost-effectiveness and budget impact of covering Burkitt’s Lymphoma in children under Ghana’s National Health Insurance Scheme

Contact Info

Product

Resources

About