title: Experience with B-cell lymphoma at a South African centre in the HIV Era.
abstract: BACKGROUND
  In South Africa most cases of Burkitt lymphoma (BL) are sporadic, and constituted the majority of paediatric B-cell lymphomas (BCL) prior to the HIV epidemic. The purpose of the study was to review the results for HIV-negative children with BCL, to assess the effect of HIV-AIDS and to determine the optimum treatment for HIV-positive children.
  
  
  METHODS
  The study was a retrospective folder review of patients with BCL at Red Cross Children's Hospital between 1991 and 2011.
  
  
  RESULTS
  One hundred and fourteen patients with BCL were diagnosed; 98 with BL, 14 with Diffuse Large B-cell lymphoma (DLBCL) and two with other forms of BCL. The proportion of DLBCL was 6.5% among HIV-negative and 36.4% among HIV-positive patients. Ninety-one HIV-negative patients were treated with LMB-based regimens. Event free survival (EFS) was 79%, with EFS for Groups A, B and C of 100%, 82.5% and 67.5%. Twenty-two HIV-positive patients were diagnosed since 2003, increasing the average number of cases from 4.3 per year to 6.9 per year. All had access to anti-retrovirals and 15 were treated with curative intent. EFS for the whole group was 58.4%. Since 2009 we have used LMB-based regimens achieving complete remission in six patients without excessive toxicity.
  
  
  CONCLUSIONS
  Results for HIV-negative patients are acceptable, but there is a need to improve outcomes for patients with combined bone marrow and CNS disease. HIV-AIDS has increased the number of BCLs with a higher proportion of DLBCL, and portends a poorer prognosis. Early evidence suggests we can achieve comparable outcomes without excessive toxicity by employing LMB-based regimens.
authors.affiliation: Haematology-Oncology Service, Department of Paediatrics and Child Health, University of Cape Town, South Africa. alan.davidson@uct.ac.za
authors.forename: Alan
authors.initials: A
authors.lastname: Davidson
authors.forename: Marc
authors.initials: M
authors.lastname: Hendricks
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000473:pathology* / Q000628:therapy*; D006801:Humans; D007223:Infant; D016483:Lymphoma, AIDS-Related / Q000473:pathology* / Q000628:therapy* / Q000821:virology; D016393:Lymphoma, B-Cell / Q000473:pathology / Q000628:therapy* / Q000821:virology*; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D013019:South Africa