title: Burkitt's lymphoma treatment in a rural hospital in Sierra Leone.
abstract: BACKGROUND
  Sierra Leone is a low-income sub-Saharan country in the endemic Burkitt's lymphoma (BL) belt. We performed a prospective trial of a reduced-intensity chemotherapy protocol for the treatment of paediatric BL.
  
  
  METHODS
  The trial included all children clinically diagnosed with BL between 2005 and 2008. Biopsy, bone-marrow aspiration, analysis of cerebrospinal fluid, abdominal ultrasound and plain x-ray of involved sites were performed when feasible. The treatment protocol was a first i.v. dose of cyclophosphamide (CPM) 40 mg/kg, followed by oral CPM weekly for two doses and then bimonthly to a total of six doses. Treatment was based on clinical diagnosis as it was several weeks before pathology results were available.
  
  
  RESULTS
  Eighty-seven patients were included, with a median age 7 years and 4 months; 59/87 (67.8%) were boys. Nearly half (n = 17, 42.5%), presented with moderate or severe malnutrition. Biopsy was performed in 44 patients, BL being verified in 36 (41.4% of all patients). Most children presented with advanced disease: 28 (32%) at stage II, 47 (54%) at stage III and 12 (13.8%) at stage IV. Most patients (71/87, 82%) initially responded to treatment, but just over half (47/87, 54%) experienced relapse and refractory disease. Forty patients (46%) in complete or partial clinical response were lost to follow-up.
  
  
  CONCLUSIONS
  The outcome for BL in rural Sierra Leone according to this protocol is poor. Low-dose CPM was ineffective. Constraints on performing complete diagnosis and staging, frequency of advanced disease at presentation and a high drop-out rate might explain our poor results.
authors.affiliation: St John of God Hospital, Mabesseneh, Sierra Leone.
authors.forename: M
authors.initials: M
authors.lastname: San Roman
authors.forename: F
authors.initials: F
authors.lastname: Aguilo
authors.forename: M
authors.initials: M
authors.lastname: Clapes
authors.forename: M
authors.initials: M
authors.lastname: Sheku
authors.forename: P
authors.initials: P
authors.lastname: Dawoh
authors.forename: J
authors.initials: J
authors.lastname: Mora
authors.forename: O
authors.initials: O
authors.lastname: Cruz
mesh_terms: D061605:Administration, Intravenous; D000284:Administration, Oral; D000293:Adolescent; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage / Q000627:therapeutic use*; D002051:Burkitt Lymphoma / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000627:therapeutic use*; D003906:Developing Countries; D005260:Female; D006780:Hospitals, Rural / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008297:Male; D055118:Medication Adherence; D009367:Neoplasm Staging; D010865:Pilot Projects; D012807:Sierra Leone / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D018906:Antineoplastic Agents, Alkylating; D003520:Cyclophosphamide
keywords: Burkitt's lymphoma; Cyclophosphamide; Developing countries; Medical oncology; Paediatrics; Treatment outcome