BACKGROUND: The French African Group of Pediatric Oncology was set-up to improve quality of care for children with cancer. Preliminary observations on the efficacy in Burkitt lymphoma (BL) of a cyclophosphamide monotherapy (CPM) have been published. We report the results of a multicentric prospective study combining first-line CPM and a multidrug second-line chemotherapy (SC) for refractory/relapsed patients. PROCEDURE: Patients ≤ 18 years with Burkitt or Burkitt-like lymphoma, were included in six countries (Burkina-Faso, Cameroon, Ivory Coast, Madagascar, Mali, and Senegal). All patients received three weekly CPM courses (1.2 g/m(2) IV with intrathecal methotrexate and hydrocortisone), stage 3/4 patients received three further courses. SC added methotrexate, vincristine, cytarabine, and prednisone. RESULTS: There were 178 patients included (42 stage 1/2, 134 stage 3/4, and 2 unknown). Isolated facial localization was found in 41 patients, diffuse abdominal involvement in 120 patients including 65 with both. Nine early deaths were reported, toxicity occurred in 136/743 courses (83 patients) and was predominantly hematological. After CPM, complete remission (CR) rate was 47% with a 33% EFS. Because of rapid progression 76/108 eligible patients (85 primary refractory and 23 relapses) received SC resulting in 35.7% CR but a 21% toxic death rate. The OS of the whole strategy was 50.5% and correlated to stage. CONCLUSION: A prospective multicentric study on BL was feasible in very low-income countries. CPM can be recommended in stage 1-2 because of optimal cost/benefit ratio. However, more intensive strategies, still adapted to socio-economic conditions, are required for advanced stages 3 and 4.
BACKGROUND: The French African Group of Pediatric Oncology was set-up to improve quality of care for children with cancer. Preliminary observations on the efficacy in Burkitt lymphoma (BL) of a cyclophosphamide monotherapy (CPM) have been published. We report the results of a multicentric prospective study combining first-line CPM and a multidrug second-line chemotherapy (SC) for refractory/relapsed patients. PROCEDURE: Patients ≤ 18 years with Burkitt or Burkitt-like lymphoma, were included in six countries (Burkina-Faso, Cameroon, Ivory Coast, Madagascar, Mali, and Senegal). All patients received three weekly CPM courses (1.2 g/m(2) IV with intrathecal methotrexate and hydrocortisone), stage 3/4 patients received three further courses. SC added methotrexate, vincristine, cytarabine, and prednisone. RESULTS: There were 178 patients included (42 stage 1/2, 134 stage 3/4, and 2 unknown). Isolated facial localization was found in 41 patients, diffuse abdominal involvement in 120 patients including 65 with both. Nine early deaths were reported, toxicity occurred in 136/743 courses (83 patients) and was predominantly hematological. After CPM, complete remission (CR) rate was 47% with a 33% EFS. Because of rapid progression 76/108 eligible patients (85 primary refractory and 23 relapses) received SC resulting in 35.7% CR but a 21% toxic death rate. The OS of the whole strategy was 50.5% and correlated to stage. CONCLUSION: A prospective multicentric study on BL was feasible in very low-income countries. CPM can be recommended in stage 1-2 because of optimal cost/benefit ratio. However, more intensive strategies, still adapted to socio-economic conditions, are required for advanced stages 3 and 4.
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 Journal: Br J Haematol Date: 2016-02-23 Impact factor: 6.998
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Authors: Yvette L Kasamon; Robert A Brodsky; Michael J Borowitz; Richard F Ambinder; Pamela A Crilley; Steve Y Cho; Hua-ling Tsai; B Douglas Smith; Douglas E Gladstone; Hetty E Carraway; Carol Ann Huff; William H Matsui; Javier Bolaños-Meade; Richard J Jones; Lode J Swinnen Journal: Leuk Lymphoma Date: 2012-08-17
Authors: Véronique Minard-Colin; Laurence Brugières; Alfred Reiter; Mitchell S Cairo; Thomas G Gross; Wilhelm Woessmann; Birgit Burkhardt; John T Sandlund; Denise Williams; Marta Pillon; Keizo Horibe; Anne Auperin; Marie-Cécile Le Deley; Martin Zimmerman; Sherrie L Perkins; Martine Raphael; Laurence Lamant; Wolfram Klapper; Lara Mussolin; Hélène A Poirel; Elizabeth Macintyre; Christine Damm-Welk; Angelo Rosolen; Catherine Patte Journal: J Clin Oncol Date: 2015-08-24 Impact factor: 44.544