Clinical features and treatment of childhood malignant lymphoma in Uganda

Abstract

A series of 66 patients with Burkitt's lymphoma or childhood lymphoma of the histiocytic or lymphoblastic type has been analysed. The six patients with histiocytic lymphomas had clinical features, response to therapy and survival rates which clearly distinguished this group from Burkitt's lymphoma. Of the six patients with lymphoblastic lymphomas, however, three presented with clinical features indistinguishable from Burkitt's lymphoma while two had facial tumors which showed atypical features. The response to chemotherapy with CTX was more favorable in the lymphoblastic than in the histiocytic group, and the survival rate in this small number of patients falls midway between those of histiocytic lymphoma and Burkitt's lymphoma. Thus, the clinical evaluation of Ugandan children with lymphoblastic lymphoma did not clearly distinguish this group from patients with Burkitt's lymphoma, and casts some doubt on the use of clinical features or response to therapy as diagnostic criteria.

Intrathecal Chemotherapy in Burkitt's Lymphoma

“…The cerebrospinal fluid (C.S.F.) cytology was examined on admission and at least at monthly intervals, several methods (Steel et al, 1965;Ziegler et al, 1970a) being used to detect the presence of malignant cells. The patients were clinically staged according to criteria previously outlined (Ziegler et al, 1970b); these are summarized in Table I. Previous to August 1969 systemic treatment consisted of intravenous cyclophosphamide, 40 mg/kg, given in one-dose or six-dose schedules (multiple doses given at intervals of two to three weeks) to randomly selected patients who had a complete response following the first dose (Ziegler et al, 1970b).…”

“…In a previous communication from this centre (Ziegler et al, 1970a) the neurological features of Burkitt's lymphoma were described. The presence of Burkitt lymphoma cells in the cerebrospinal fluid (malignant pleocytosis) was a prominent finding, and though patients with this complication were initially responsive to intrathecal chemotherapy, relapse was common and the prognosis was poor.…”

“…The presence of Burkitt lymphoma cells in the cerebrospinal fluid (malignant pleocytosis) was a prominent finding, and though patients with this complication were initially responsive to intrathecal chemotherapy, relapse was common and the prognosis was poor. In a neoplasm characterized by dramatic and often durable remissions following chemotherapy the successful management of malignant pleocytosis presents a major therapeutic challenge (Clifford et al, 1967;Ziegler et al, 1970a). We have now treated 55 episodes of malignant pleocytosis in 38 patients with Burkitt's lymphoma utilizing methotrexate and cytosine arabinoside in seven different intrathecal regimens.…”

Differential diagnosis of Burkitt's lymphoma of the face and jaws

“…We currently believe that Burkitt's lymphoma is composed of undifferentiated "stem cells" and that tumors showing either histiocytic or lymphocytic differentiation should not be classified as Burkitt's lymphoma. 16 T h e majority of these differentiated lymphomas do not simulate Burkitt's lymphoma clinically, and in case 3 the resemblance both anatomically and behaviorally is seen to be superficial. Six of the cases referred to the Lymphoma Treatment Center as cases of Burkitt's lymphoma were examples of embryonal rhabdomyosarcoma.…”

Growth Inhibitors Rapidly Inactivated by the Host as Potential Antineoplastic Agents in Intra-Arterial Infusion Chemotherapy

“…Successes in the treatment of choriocarcinomas with methotrexate [2,54,55] and of Burkitt's lymphoma with cyclophosphamide [98], as well as the unpredict able occasional cure of a malignant neoplasm in patients undergoing therapy with antimetabolites or alkylating agents [42], provide sufficient impetus for continuing the search for cytocidal agents which have increased specificity for malignant cells compared with sensitive host cells and tissues. However, alternative chemotherapeutic approaches stemming from somewhat different assumptions must not be neglected.…”