Sarita Depani1,2, Kondwani Banda1, Simon Bailey3, Trijn Israels4, George Chagaluka1, Elizabeth Molyneux1. 1. Department of Paediatric, Queen Elizabeth Central Hospital, Blantyre, Malawi. 2. Children and Young People's Cancer Service, University College Hospital, London, UK. 3. Department of Paediatric Oncology, Great North Childrens Hospital, Newcastle, UK. 4. Department of Paediatric Oncology, Outreach Programme, VU University Medical Centre, Amsterdam, the Netherlands.
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). CONCLUSION: The addition of vincristine to the Malawi 28 day BL treatment protocol did not improve survival.
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). CONCLUSION: The addition of vincristine to the Malawi 28 day BL treatment protocol did not improve survival.
Authors: Katherine D Westmoreland; Nader K El-Mallawany; Peter Kazembe; Christopher C Stanley; Satish Gopal Journal: Br J Haematol Date: 2017-07-17 Impact factor: 6.998
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Authors: Nader Kim El-Mallawany; Mercy Mutai; Idah Mtete; Satish Gopal; Christopher C Stanley; Peter Wasswa; Mary Mtunda; Mary Chasela; William Kamiyango; Jimmy Villiera; Yuri Fedoriw; Nathan D Montgomery; George N Liomba; Coxcilly Kampani; Robert Krysiak; Katherine D Westmoreland; Maria H Kim; Jeremy S Slone; Michael E Scheurer; Carl E Allen; Parth S Mehta; Peter N Kazembe Journal: Glob Pediatr Health Date: 2017-06-23