title: Treatment of children with B-cell non-Hodgkin lymphoma in a low-income country.
abstract: BACKGROUND
  An adapted LMB 96 derived protocol for B-cell non-Hodgkin lymphoma (NHL) was implemented at the pediatric oncology unit of the Children Welfare Teaching Hospital in Baghdad (Iraq) from 2000 to present. The purpose was to evaluate the feasibility and efficacy of this intensive therapeutic regimen in a limited resource country.
  
  
  METHODS
  Patients <15 years of age with high grade B-cell NHL were included. A modified LMB 96 regimen was employed with a reduction of cyclophosphamide and methotrexate dosages due to inadequate laboratory facilities and supportive care.
  
  
  RESULTS
  Between 2000 and 2005, 261 children with non-lymphoblastic NHL were registered; 239 were eligible for the analysis. Two patients had stage I disease, 20 stage II, 179 stage III, and 38 stage IV. Fifty-two patients (22%) had bulky disease. Twelve children were assigned to therapeutic group A (low risk), 184 to group B (intermediate risk), and 43 to group C (high risk). One hundred and eighty-four patients (77%) had a complete response after the COP pre-phase. Sixty-nine patients (29%) died during treatment. Twenty-nine patients abandoned treatment. At 24 months, the overall survival rate of the entire patient population was 66% (CI 95%: 62.2-70.6) and the event-free survival rate 53.3% (CI 95%: 50.0-56.8).
  
  
  CONCLUSIONS
  The treatment schedule proved effective, but the treatment-related mortality due to infections and metabolic complications was very high owing to the limited supportive care available. The high rate of treatment abandonment was also an important cause of failure, especially for children living far away from the hospital.
authors.affiliation: Division of Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy. moleti@bce.uniroma1.it
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Moleti
authors.forename: Salma Abbas
authors.initials: SA
authors.lastname: Al-Hadad
authors.forename: Mazin Faisal
authors.initials: MF
authors.lastname: Al-Jadiry
authors.forename: Amir Fadhil
authors.initials: AF
authors.lastname: Al-Darraji
authors.forename: Raghad Majid
authors.initials: RM
authors.lastname: Al-Saeed
authors.forename: Annalisa
authors.initials: A
authors.lastname: De Vellis
authors.forename: Alfonso
authors.initials: A
authors.lastname: Piciocchi
authors.forename: Stefania
authors.initials: S
authors.lastname: Uccini
authors.forename: Robin
authors.initials: R
authors.lastname: Foà
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Testi
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001215:Asparaginase / Q000008:administration & dosage / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D003561:Cytarabine / Q000008:administration & dosage / Q000009:adverse effects; D003906:Developing Countries; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage / Q000009:adverse effects; D007493:Iraq; D016393:Lymphoma, B-Cell / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects; D011241:Prednisone / Q000008:administration & dosage / Q000009:adverse effects; D015996:Survival Rate; D014750:Vincristine / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D003561:Cytarabine; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D005492:Folic Acid; D001215:Asparaginase; D011241:Prednisone; D006854:Hydrocortisone; D008727:Methotrexate