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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
biochemistry, genetics and molecular biology
Malawi Pilot Study of Burkitt Lymphoma Treatment
Medical and Pediatric Oncology, Volume 41, No. 6, Year 2003
Notification
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Description
Background. Burkitt lymphoma (BL) accounts for 50% of childhood cancer in Malawi. Lack of resources precludes the use of new successful treatment approaches such as the LMB 89 group B protocol, which cures >80% of children with stage III BL with high dose chemotherapy and matching supportive care. Our objective was to achieve a good cure rate in Murphy stage I-III BL with manageable toxicity in Malawi at a drug cost of <1,000 US dollars per patient. Procedure. The intensity and toxicity of the LMB 89 group B protocol was reduced and adapted to Malawi realities. All stages received the same treatment. Children with suspected BL in the period July 1997-November 1999 were subjected to abdominal ultrasound, a tumor biopsy and/or fine needle aspirate (FNA) and bone marrow (BM), cerebrospinal fluid (CSF), and peripheral blood examination. HIV seropositive children were excluded. Endpoints are projected event free survival (EFS) at minimum 1 year, blood and gastro-intestinal tract toxicity, and risk for and severity of infections. Results. Forty-four children were eligible for treatment and analysis. Their median age was 7.2 years, M:F ratio 1.4:1 with 10 stage 1, 5 stage II, and 29 stage III patients. Projected Kaplan-Meier EFS for all was 57% (CI 41-73) at 1 year with 90% EFS in stage I and 52% EFS in stage III. The survival curve remained stable at 500 days. Toxicity and delays in appropriate supportive care contributed to ten deaths during treatment. Local recurrent tumor caused five and CNS recurrence one death. Two children died from progressive disease. The incidence of severe (grade 3 and/or 4) hematologic toxicity varied from 13% to 36%, gastrointestinal toxicity (GIT) from 2% to 17%, and infections from 7% to 41% per chemotherapy module. Conclusions. It is possible to administer less intense and less costly multiagent chemotherapy to children with BL in a developing society with acceptable EFS rates. Adequate supportive care of the at-times associated severe toxicity must be made available to better the results. © 2003 Wiley-Liss, Inc.
Authors & Co-Authors
Hesseling, Peter Bernard
South Africa, Stellenbosch
Stellenbosch University
Broadhead, Robin L.
Malawi, Zomba
University of Malawi
Molyneux, Elizabeth M.
Malawi, Zomba
University of Malawi
Borgstein, Eric S.
Malawi, Zomba
University of Malawi
SCHNEIDER, JOHAN W.
South Africa, Stellenbosch
Stellenbosch University
Louw, Mercia
South Africa, Stellenbosch
Stellenbosch University
Mansvelt, Erna P.G.
South Africa, Stellenbosch
Stellenbosch University
Wessels, Glynn U.
South Africa, Stellenbosch
Stellenbosch University
Statistics
Citations: 77
Authors: 8
Affiliations: 2
Identifiers
Doi:
10.1002/mpo.10322
ISSN:
00981532
Research Areas
Cancer
Health System And Policy
Infectious Diseases
Maternal And Child Health
Study Design
Cohort Study
Case-Control Study
Study Locations
Malawi