title: Outcome is unchanged by adding vincristine upfront to the Malawi 28-day protocol for endemic Burkitt lymphoma.
abstract: BACKGROUND
  We previously reported a 28-day treatment protocol for children with endemic Burkitt lymphoma (BL) which included four doses of cyclophosphamide (CPM), intrathecal methotrexate and hydrocortisone (IT MTX/HC) at Queen Elizabeth Central Hospital (QECH) in Malawi which resulted in an Event-Free Survival (EFS) of 50% at 1 year.
  
  
  METHODS
  In an attempt to improve survival whilst maintaining acceptable toxicity, brevity, low-cost and a standard treatment for all patients, four doses of vincristine (VCR) at 1.5 mg/m(2) were added to the backbone of CPM 40 mg/kg on day 1 and 60 mg/kg on days 8,18 and 28 and IT MTX /HC 12.5 mg on days 1,8,18 and 28.
  
  
  RESULTS
  Seventy cytology confirmed cases of BL, 42 males and 28 females with a median age of 80 years, were treated with this protocol between January 2010 and April 2012. Four percent had St Jude Stage I disease; 29% Stage II; 30% Stage III and 37% Stage IV. Disease site in order of frequency was face (64%); abdomen (47%); CSF (26%) and paraspinal (17%). There were two on-treatment deaths. Sixty-three percent required antibiotics and 19% required blood transfusion. Eighty-one percent of patients achieved complete clinical remission at day 28. Overall predicted EFS at 1 year was 48%; 100% in Stage I, 83% in Stage II, 24% in Stage III and 32% in Stage IV disease. EFS was significantly worse in patients with Stage III/IV disease (P = 0.002) and paraplegia (P = 0.002).
  
  
  CONCLUSIONS
  The addition of vincristine to the Malawi 28 day BL treatment protocol did not improve survival.
authors.affiliation: Department of Paediatric, Queen Elizabeth Central Hospital, Blantyre, Malawi.|Children and Young People's Cancer Service, University College Hospital, London, UK.
authors.forename: Sarita
authors.initials: S
authors.lastname: Depani
authors.affiliation: Department of Paediatric, Queen Elizabeth Central Hospital, Blantyre, Malawi.
authors.forename: Kondwani
authors.initials: K
authors.lastname: Banda
authors.affiliation: Department of Paediatric Oncology, Great North Childrens Hospital, Newcastle, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Bailey
authors.affiliation: Department of Paediatric Oncology, Outreach Programme, VU University Medical Centre, Amsterdam, the Netherlands.
authors.forename: Trijn
authors.initials: T
authors.lastname: Israels
authors.affiliation: Department of Paediatric, Queen Elizabeth Central Hospital, Blantyre, Malawi.
authors.forename: George
authors.initials: G
authors.lastname: Chagaluka
authors.affiliation: Department of Paediatric, Queen Elizabeth Central Hospital, Blantyre, Malawi.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Molyneux
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D002051:Burkitt Lymphoma / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality*; D002648:Child; D002675:Child, Preschool; D003520:Cyclophosphamide / Q000008:administration & dosage; D018572:Disease-Free Survival; D019353:Endemic Diseases; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage; D008295:Malawi / Q000453:epidemiology; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage; D009367:Neoplasm Staging; D015996:Survival Rate; D014750:Vincristine / Q000008:administration & dosage*
chemical_list: D014750:Vincristine; D003520:Cyclophosphamide; D006854:Hydrocortisone; D008727:Methotrexate
keywords: Burkitt lymphoma; Malawi; developing country; endemic; modified treatment