title: Outcomes for paediatric Burkitt lymphoma treated with anthracycline-based therapy in Malawi.
abstract: Burkitt lymphoma (BL) is the most common paediatric cancer in sub-Saharan Africa (SSA). Anthracyline-based treatment is standard in resource-rich settings, but has not been described in SSA. Children ≤18 years of age with newly diagnosed BL were prospectively enrolled from June 2013 to May 2015 in Malawi. Staging and supportive care were standardized, as was treatment with CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) for six cycles. Among 73 children with BL, median age was 9·2 years (interquartile range 7·7-11·8), 48 (66%) were male and two were positive for human immunodeficiency virus. Twelve (16%) had stage I/II disease, 36 (49%) stage III and 25 (34%) stage IV. Grade 3/4 neutropenia occurred in 17 (25%), and grade 3/4 anaemia in 29 (42%) of 69 evaluable children. Eighteen-month overall survival was 29% (95% confidence interval [CI] 18-41%) overall. Mortality was associated with age >9 years [hazard ratio [HR] 2·13, 95% CI 1·15-3·94], female gender (HR 2·12, 95% CI 1·12-4·03), stage (HR 1·52 per unit, 95% CI 1·07-2·17), lactate dehydrogenase (HR 1·03 per 100 iu/l, 95% CI 1·01-1·05), albumin (HR 0·96 per g/l, 95% CI 0·93-0·99) and performance status (HR 0·78 per 10-point increase, 95% CI 0·69-0·89). CHOP did not improve outcomes in paediatric BL compared to less intensive regimens in Malawi.
authors.affiliation: UNC Project-Malawi, Lilongwe, Malawi.
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Stanley
authors.affiliation: UNC Project-Malawi, Lilongwe, Malawi.
authors.forename: Kate D
authors.initials: KD
authors.lastname: Westmoreland
authors.affiliation: UNC Project-Malawi, Lilongwe, Malawi.
authors.forename: Brett J
authors.initials: BJ
authors.lastname: Heimlich
authors.affiliation: New York Medical College, Valhalla, New York.
authors.forename: Nader K
authors.initials: NK
authors.lastname: El-Mallawany
authors.affiliation: Texas Children's Hospital, Houston, Texas.
authors.forename: Peter
authors.initials: P
authors.lastname: Wasswa
authors.affiliation: Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.
authors.forename: Idah
authors.initials: I
authors.lastname: Mtete
authors.affiliation: Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.
authors.forename: Mercy
authors.initials: M
authors.lastname: Butia
authors.affiliation: UNC Project-Malawi, Lilongwe, Malawi.
authors.forename: Salama
authors.initials: S
authors.lastname: Itimu
authors.affiliation: Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.
authors.forename: Mary
authors.initials: M
authors.lastname: Chasela
authors.affiliation: Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.
authors.forename: Mary
authors.initials: M
authors.lastname: Mtunda
authors.affiliation: UNC Project-Malawi, Lilongwe, Malawi.
authors.forename: Mary
authors.initials: M
authors.lastname: Chikasema
authors.affiliation: UNC Project-Malawi, Lilongwe, Malawi.
authors.forename: Victor
authors.initials: V
authors.lastname: Makwakwa
authors.affiliation: UNC Project-Malawi, Lilongwe, Malawi.
authors.forename: Bongani
authors.initials: B
authors.lastname: Kaimila
authors.affiliation: UNC Project-Malawi, Lilongwe, Malawi.
authors.forename: Edwards
authors.initials: E
authors.lastname: Kasonkanji
authors.affiliation: UNC Project-Malawi, Lilongwe, Malawi.
authors.forename: Fred
authors.initials: F
authors.lastname: Chimzimu
authors.affiliation: UNC Project-Malawi, Lilongwe, Malawi.
authors.forename: Coxcilly
authors.initials: C
authors.lastname: Kampani
authors.affiliation: UNC Project-Malawi, Lilongwe, Malawi.
authors.forename: Bal M
authors.initials: BM
authors.lastname: Dhungel
authors.affiliation: UNC Project-Malawi, Lilongwe, Malawi.
authors.forename: Robert
authors.initials: R
authors.lastname: Krysiak
authors.affiliation: University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Nathan D
authors.initials: ND
authors.lastname: Montgomery
authors.affiliation: University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Yuri
authors.initials: Y
authors.lastname: Fedoriw
authors.affiliation: UNC Project-Malawi, Lilongwe, Malawi.|University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Nora E
authors.initials: NE
authors.lastname: Rosenberg
authors.affiliation: UNC Project-Malawi, Lilongwe, Malawi.
authors.forename: N George
authors.initials: NG
authors.lastname: Liomba
authors.affiliation: UNC Project-Malawi, Lilongwe, Malawi.|University of North Carolina, Chapel Hill, North Carolina.|University of Malawi College of Medicine, Blantyre, Malawi.
authors.forename: Satish
authors.initials: S
authors.lastname: Gopal
mesh_terms: D000367:Age Factors; D018943:Anthracyclines / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002051:Burkitt Lymphoma / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality; D002648:Child; D003520:Cyclophosphamide / Q000627:therapeutic use; D004317:Doxorubicin / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008295:Malawi / Q000453:epidemiology; D008297:Male; D009367:Neoplasm Staging; D011241:Prednisone / Q000627:therapeutic use; D011446:Prospective Studies; D012737:Sex Factors; D016896:Treatment Outcome; D014750:Vincristine / Q000627:therapeutic use
chemical_list: D018943:Anthracyclines; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone
keywords: Burkitt lymphoma; Epstein-Barr virus; Malawi; paediatric cancer; sub-Saharan Africa