Outcomes for paediatric Burkitt lymphoma treated with anthracycline‐based therapy in Malawi |
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Authors: | Christopher C. Stanley Kate D. Westmoreland Brett J. Heimlich Nader K. El‐Mallawany Peter Wasswa Idah Mtete Mercy Butia Salama Itimu Mary Chasela Mary Mtunda Mary Chikasema Victor Makwakwa Bongani Kaimila Edwards Kasonkanji Fred Chimzimu Coxcilly Kampani Bal M. Dhungel Robert Krysiak Nathan D. Montgomery Yuri Fedoriw Nora E. Rosenberg N. George Liomba Satish Gopal |
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Affiliation: | 1. UNC Project‐Malawi, Lilongwe, Malawi;2. New York Medical College, Valhalla, New York;3. Texas Children's Hospital, Houston, Texas;4. Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi;5. University of North Carolina, Chapel Hill, North Carolina;6. University of Malawi College of Medicine, Blantyre, Malawi |
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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. |
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Keywords: | Burkitt lymphoma Malawi sub‐Saharan Africa paediatric cancer Epstein‐Barr virus |
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