title: Treatment of Burkitt lymphoma in equatorial Africa using a simple three-drug combination followed by a salvage regimen for patients with persistent or recurrent disease.
abstract: Prior to the introduction of the International Network for Cancer Treatment and Research (INCTR) protocol INCTR 03-06, survival of patients with Burkitt lymphoma at four tertiary care centres in equatorial Africa was probably no more than 10-20%. The results reported here for 356 patients have demonstrated marked improvement in survival through the use of a uniform treatment protocol consisting of cyclophosphamide, methotrexate, vincristine, and intrathecal therapy, and the introduction of non-cross resistant second-line (salvage) therapy, consisting of ifosfamide, mesna, etoposide and cytarabine, when patients failed to achieve a complete response to first-line therapy or relapsed early. Overall survival rates of 67% and 62% were observed at 1 and 2 years (relapse is rare after 1 year of remission). Of interest was the small impact of cerebrospinal fluid (CSF) and bone marrow involvement on outcome. However, the presence or absence of abdominal involvement clearly defined two prognostic groups. An additional finding was the association between CSF pleocytosis and orbital tumours, suggesting that spread of tumour cells to the central nervous system may sometimes occur via direct involvement of cranial nerves in the orbit. Survival rates may be increased in patients with abdominal involvement by combining first- and second-line therapy, but verification will require a further clinical study.
authors: Ocean Road Cancer Institute, Dar es Salaam, Tanzania.
authors: Twalib
authors: T
authors: Ngoma
authors: Melissa
authors: M
authors: Adde
authors: Muheez
authors: M
authors: Durosinmi
authors: Jessie
authors: J
authors: Githang'a
authors: Yetunde
authors: Y
authors: Aken'Ova
authors: Jane
authors: J
authors: Kaijage
authors: Oluwagbemiga
authors: O
authors: Adeodou
authors: Jamilla
authors: J
authors: Rajab
authors: Biobele J
authors: BJ
authors: Brown
authors: Lorenzo
authors: L
authors: Leoncini
authors: Kikkeri
authors: K
authors: Naresh
authors: Martine
authors: M
authors: Raphael
authors: Nina
authors: N
authors: Hurwitz
authors: Patricia
authors: P
authors: Scanlan
authors: Ama
authors: A
authors: Rohatiner
authors: David
authors: D
authors: Venzon
authors: Ian
authors: I
authors: Magrath
mesh_terms: D000293:Adolescent; D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D002051:Burkitt Lymphoma / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D003561:Cytarabine / Q000008:administration & dosage / Q000009:adverse effects; D005047:Etoposide / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage / Q000009:adverse effects; D053208:Kaplan-Meier Estimate; D008297:Male; D015080:Mesna / Q000008:administration & dosage / Q000009:adverse effects; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects; D008875:Middle Aged; D009367:Neoplasm Staging; D012008:Recurrence; D012074:Remission Induction; D012306:Risk; D016879:Salvage Therapy; D015996:Survival Rate; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage / Q000009:adverse effects; D055815:Young Adult
chemical_list: D003561:Cytarabine; D014750:Vincristine; D005047:Etoposide; D003520:Cyclophosphamide; D015080:Mesna; D007069:Ifosfamide; D008727:Methotrexate