The evolving management of Burkitt's lymphoma at Red Cross Children's Hospital.
BACKGROUND
Treatment for Burkitt's lymphoma at Red Cross Children's Hospital has evolved from the use of aggressive surgery and less intensive chemotherapy to a conservative surgical approach with more intensive chemotherapy.


METHODS
The study was a retrospective folder review of patients diagnosed with Burkitt's lymphoma at RCCH between 1984 and 2004.


RESULTS
Ninety-two children were treated for Burkitt's lymphoma at RCCH between 1984 and 2004. There were 10 patients with group A or fully resected disease, 52 with group B or extensive localised disease, and 30 with dissemination to the bone marrow and/or central nervous system or group C disease. Protocol 1 (less intensive chemotherapy based on the COMP regimen) was used from 1984, with protocol 2 (more intensive chemotherapy based on the LMB regimen) introduced in 1988 for group C disease, 1991 for group B disease and 1996 for group A disease. Overall 5-year survival increased from 20% with protocol 1 to 66% with protocol 2 for group C disease, and from 76.5% with protocol 1 to 88.2% with protocol 2 for group B disease. There were more admissions for neutropenic fever in patients on protocol 2 and more episodes of mucositis, and these patients required more red cell and platelet transfusions. With a more conservative surgical approach, biopsy largely replaced attempts to partially resect the tumour at primary surgery, and there was a consequent decline in surgical complications.


CONCLUSIONS
Intensive chemotherapy with protocol 2 has resulted in improved survival for group C and group B patients, but with more morbidity. Protocol 1, which is less intensive with less morbidity, remains a viable strategy for group A and group B disease in resource-poor settings.
Davidson
Alan
A
Haematology Oncology Service, School of Child and Adolescent Health, Red Cross War Memorial Children's Hospital and University of Cape Town, South Africa. davidson@ich.uct.ac.za
Desai
Farieda
F
Hendricks
Marc
M
Hartley
Patricia
P
Millar
Alastair
A
Numanoglu
Alp
A
Rode
Heinz
H
D000293:Adolescent; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002051:Burkitt Lymphoma / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006766:Hospitals, County; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D013019:South Africa / Q000453:epidemiology; D015996:Survival Rate; D016896:Treatment Outcome
D000970:Antineoplastic Agents