Cyclophosphamide monotherapy in children with Burkitt lymphoma: a study from the French-African Pediatric Oncology Group (GFAOP).
BACKGROUND
The French African Group of Pediatric Oncology was set-up to improve quality of care for children with cancer. Preliminary observations on the efficacy in Burkitt lymphoma (BL) of a cyclophosphamide monotherapy (CPM) have been published. We report the results of a multicentric prospective study combining first-line CPM and a multidrug second-line chemotherapy (SC) for refractory/relapsed patients.


METHODS
Patients ≤ 18 years with Burkitt or Burkitt-like lymphoma, were included in six countries (Burkina-Faso, Cameroon, Ivory Coast, Madagascar, Mali, and Senegal). All patients received three weekly CPM courses (1.2 g/m(2) IV with intrathecal methotrexate and hydrocortisone), stage 3/4 patients received three further courses. SC added methotrexate, vincristine, cytarabine, and prednisone.


RESULTS
There were 178 patients included (42 stage 1/2, 134 stage 3/4, and 2 unknown). Isolated facial localization was found in 41 patients, diffuse abdominal involvement in 120 patients including 65 with both. Nine early deaths were reported, toxicity occurred in 136/743 courses (83 patients) and was predominantly hematological. After CPM, complete remission (CR) rate was 47% with a 33% EFS. Because of rapid progression 76/108 eligible patients (85 primary refractory and 23 relapses) received SC resulting in 35.7% CR but a 21% toxic death rate. The OS of the whole strategy was 50.5% and correlated to stage.


CONCLUSIONS
A prospective multicentric study on BL was feasible in very low-income countries. CPM can be recommended in stage 1-2 because of optimal cost/benefit ratio. However, more intensive strategies, still adapted to socio-economic conditions, are required for advanced stages 3 and 4.
Service de Pédiatrie, Hôpital Gabriel Touré, Bamako, Mali.
Fousseyni
F
Traoré
Carole
C
Coze
Jean-Jacques
JJ
Atteby
Nicolas
N
André
Claude
C
Moreira
Pierre
P
Doumbe
Noeline
N
Ravelomanana
Diarra
D
Ye
Catherine
C
Patte
Marie-Anne
MA
Raquin
Martine
M
Raphael
Jean
J
Lemerle
D000293:Adolescent; D018906:Antineoplastic Agents, Alkylating; D002051:Burkitt Lymphoma / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D003520:Cyclophosphamide / Q000008:administration & dosage* / Q000633:toxicity; D003906:Developing Countries; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008302:Mali; D009367:Neoplasm Staging; D011446:Prospective Studies; D012074:Remission Induction; D016879:Salvage Therapy / Q000379:methods; D015996:Survival Rate
D018906:Antineoplastic Agents, Alkylating; D003520:Cyclophosphamide