Malawi pilot study of Burkitt lymphoma treatment.
BACKGROUND
Burkitt lymphoma (BL) accounts for 50% of childhood cancer in Malawi. Lack of resources precludes the use of new successful treatment approaches such as the LMB 89 group B protocol, which cures >80% of children with stage III BL with high dose chemotherapy and matching supportive care. Our objective was to achieve a good cure rate in Murphy stage I-III BL with manageable toxicity in Malawi at a drug cost of <1000 US dollars per patient.


METHODS
The intensity and toxicity of the LMB 89 group B protocol was reduced and adapted to Malawi realities. All stages received the same treatment. Children with suspected BL in the period July 1997-November 1999 were subjected to abdominal ultrasound, a tumor biopsy and/or fine needle aspirate (FNA) and bone marrow (BM), cerebrospinal fluid (CSF), and peripheral blood examination. HIV seropositive children were excluded. Endpoints are projected event free survival (EFS) at minimum 1 year, blood and gastro-intestinal tract toxicity, and risk for and severity of infections.


RESULTS
Forty-four children were eligible for treatment and analysis. Their median age was 7.2 years, M:F ratio 1.4:1 with 10 stage I, 5 stage II, and 29 stage III patients. Projected Kaplan-Meier EFS for all was 57% (CI 41-73) at 1 year with 90% EFS in stage I and 52% EFS in stage III. The survival curve remained stable at 500 days. Toxicity and delays in appropriate supportive care contributed to ten deaths during treatment. Local recurrent tumor caused five and CNS recurrence one death. Two children died from progressive disease. The incidence of severe (grade 3 and/or 4) hematologic toxicity varied from 13% to 36%, gastro-intestinal toxicity (GIT) from 2% to 17%, and infections from 7% to 41% per chemotherapy module.


CONCLUSIONS
It is possible to administer less intense and less costly multiagent chemotherapy to children with BL in a developing society with acceptable EFS rates. Adequate supportive care of the at-times associated severe toxicity must be made available to better the results.
Department of Paediatrics at the Health Sciences Faculty, University of Stellenbosch, Tygerberg, South Africa. pbh@sun.ac.za
Peter B
PB
Hesseling
Robin
R
Broadhead
Elizabeth
E
Molyneux
Eric
E
Borgstein
Johann W
JW
Schneider
Mercia
M
Louw
Erna P G
EP
Mansvelt
Glynn
G
Wessels
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics* / Q000627:therapeutic use*; D002051:Burkitt Lymphoma / Q000188:drug therapy* / Q000191:economics*; D002648:Child; D002675:Child, Preschool; D003363:Cost Control; D003906:Developing Countries; D018450:Disease Progression; D018572:Disease-Free Survival; D016527:Drug Costs; D005260:Female; D006801:Humans; D008295:Malawi; D008297:Male; D009367:Neoplasm Staging; D011379:Prognosis