Dissecting heterogeneous outcomes for paediatric Burkitt lymphoma in Malawi after anthracycline‐based treatment

Westmoreland, Katherine D.; El‐Mallawany, Nader Kim; Kazembe, Peter N.; Stanley, Christopher C.; Gopal, Satish

doi:10.1111/bjh.14716

Cited by 5 publications

(16 citation statements)

References 7 publications

(13 reference statements)

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“…43 One-year overall survival was 47% (95% CI [37-59%]), which is consistent with historical and published survival rates for Burkitt lymphoma across SSA, and is significantly worse than reported survival rates of >90% in HIC. 2,22,[43][44][45][46][47] Given the high mortality and the challenges associated with cancer treatment in resource-poor health systems, appropriate risk stratification of patients is critical in SSA, where administering aggressive treatment to optimize survival must be weighed against toxicity risks for vulnerable children. Poor LPS has consistently been identified as a risk factor for mortality in research from both LMICs and HICs.…”

Section: Discussionmentioning

confidence: 99%

“…Poor LPS has consistently been identified as a risk factor for mortality in research from both LMICs and HICs. 2,22,45,46,48 Further, emerging data from HICs suggest PROs offer superior assessment of performance status when compared to traditional physician-reported measures. 49 We observed significantly increased mortality risk and worse survival in our cohort among patients with physician-reported LPS [?]…”

Section: Discussionmentioning

confidence: 99%

“…All patients were enrolled in the KCH Lymphoma study, an observational prospective cohort study that began in 2013, and were followed for two years after treatment completion. 2,22,23 Patients were staged using physical examination, chest radiography, abdominal ultrasound, unilateral bone marrow biopsy, and cerebrospinal fluid cytology, as previously described. 2,22 The clinician-reported Lansky performance score (LPS), routinely used in cancer clinical trials for children <16 years, was obtained at diagnosis.…”

Section: Participantsmentioning

confidence: 99%

“…21 Standard chemotherapy regimens were administered and evolved during the study period, and as previously described: Hodgkin lymphoma patients received ABVE-PC regimen (doxorubicin, bleomycin, vincristine, etoposide -prednisone & cyclophosphamide); low-risk Burkitt Lymphoma patients received COMP (cyclophosphamide, vincristine, methotrexate and prednisone); and high-risk Burkitt lymphoma initially received CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) and more recently received modified CO-PADM (cyclophosphamide, vincristine, prednisone, doxorubicin, methotrexate). 2,22,23 Radiotherapy is not available in Malawi.…”

Section: Participantsmentioning

confidence: 99%

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Pediatric lymphoma patients in Malawi present with poor health-related quality of life at diagnosis, and improve throughout treatment and follow-up across all Pediatric PROMIS-25 domains.

Ellis¹,

Chapman

Manda³

et al. 2020

Preprint

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Participantsmentioning

confidence: 99%

Section: Participantsmentioning

confidence: 99%

See 2 more Smart Citations

Pediatric lymphoma patients in Malawi present with poor health-related quality of life at diagnosis, and improve throughout treatment and follow-up across all Pediatric PROMIS-25 domains.

Ellis¹,

Chapman

Manda³

et al. 2020

Preprint

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show abstract

“…It is challenging to definitively explain the differences in treatment outcomes, but potential factors may include differences in inclusion criteria, methods of risk stratification, response measurement, or follow-up. 55 Additionally, the cohort in Blantyre may have benefited from expedited pathology analyses through the aforementioned telepathology collaboration via a partnership with a United Kingdom-based institution, potentially enabling a patient population with less-advanced-stage disease. 21 Ultimately though, the less favorable outcomes from the region are similar to historic results from St. Jude Children's Research Hospital (Memphis, TN) from the 1970s, where a similar regimen combining cyclophosphamide, vincristine, prednisone, and doxorubicin, with or without involved-field radiation therapy, resulted in a 2-year disease-free survival of 38.8% for patients with stage III/IV disease.…”

Section: Contemporary Standards and Efforts To Improve Bl Treatment Imentioning

confidence: 99%

Five decades of low intensity and low survival: adapting intensified regimens to cure pediatric Burkitt lymphoma in Africa

et al. 2020

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Long-term cure of childhood Burkitt lymphoma (BL) in sub-Saharan Africa after treatment with single-agent cyclophosphamide has been documented for more than half of a century. Contemporary cure rates for the highest-risk patients with BL in high-income countries exceed 90% using intensive multiagent chemotherapy. By contrast, the majority of African children with BL still die. Data spanning 5 decades in Africa have repeatedly shown that the children most likely to achieve cure with limited cyclophosphamide regimens are those with lower-stage disease isolated to the jaw. Attempts to intensify the cyclophosphamide monotherapy backbone with the addition of vincristine, low-dose methotrexate, prednisone, doxorubicin, and/or low-dose cytarabine have not yielded significant improvement. High-dose methotrexate is a critical component in the treatment of childhood BL worldwide. Although initial efforts in Africa to incorporate high-dose methotrexate resulted in high treatment-related mortality, more recent collaborative experiences from North and West Africa, as well as Central America, demonstrate that it can be administered safely and effectively, despite limitations in supportive care resources. Recognizing the unacceptable disparity in curative outcomes for BL between the United States/Europe and equatorial Africa, there is a critical need to safely adapt contemporary treatment regimens to optimize curative outcomes amid the resource limitations in regions where BL is endemic. Here, we critically review reports of BL treatment outcomes from low- and middle-income countries, in addition to data from high-income countries that predated modern intensified regimens, to identify potential strategies to improve the therapeutic approach for children suffering from BL in sub-Saharan Africa.

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Pediatric lymphoma patients in Malawi present with poor health‐related quality of life at diagnosis and improve throughout treatment and follow‐up across all Pediatric PROMIS‐25 domains

Ellis¹,

Chapman

Manda³

et al. 2021

Pediatric Blood & Cancer

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Background Patient‐reportedoutcomes (PROs) that assess health‐related quality of life (HRQoL) are increasingly important components of cancer care and research that are infrequently used in sub‐Saharan Africa (SSA). Methods We administered the Chichewa Pediatric Patient‐Reported Outcome Measurement Information System Pediatric (PROMIS)‐25 at diagnosis, active treatment, and follow‐up among pediatric lymphoma patients in Lilongwe, Malawi. Mean scores were calculated for the six PROMIS‐25 HRQoL domains (Mobility, Anxiety, Depressive Symptoms, Fatigue, Peer Relationships, Pain Interference). Differences in HRQoL throughout treatment were compared using the minimally important difference (MID) and an ANOVA analysis. Kaplan–Meier survival estimates and Cox hazard ratios for mortality are reported. Results Seventy‐five children completed PROMIS‐25 surveys at diagnosis, 35 (47%) during active treatment, and 24 (32%) at follow‐up. The majority of patients died (n = 37, 49%) or were lost to follow‐up (n = 6, 8%). Most (n = 51, 68%) were male, median age was 10 (interquartile range [IQR] 8–12), 48/73 (66%) presented with advanced stage III/IV, 61 (81%) were diagnosed with Burkitt lymphoma and 14 (19%) Hodgkin lymphoma. At diagnosis, HRQoL was poor across all domains, except for Peer Relationships. Improvements in HRQoL during active treatment and follow‐up exceeded the MID. On exploratory analysis, fair‐poor PROMIS Mobility <40 and severe Pain Intensity = 10 at diagnosis were associated with increased mortality risk and worse survival, but were not statistically significant. Conclusions Pediatric lymphoma patients in Malawi present with poor HRQoL that improves throughout treatment and survivorship. Baseline PROMIS scores may provide important prognostic information. PROs offer an opportunity to include patient voices and prioritize holistic patient‐centered care in low‐resource settings.

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Dissecting heterogeneous outcomes for paediatric Burkitt lymphoma in Malawi after anthracycline‐based treatment

Cited by 5 publications

References 7 publications

Pediatric lymphoma patients in Malawi present with poor health-related quality of life at diagnosis, and improve throughout treatment and follow-up across all Pediatric PROMIS-25 domains.

Pediatric lymphoma patients in Malawi present with poor health-related quality of life at diagnosis, and improve throughout treatment and follow-up across all Pediatric PROMIS-25 domains.

Five decades of low intensity and low survival: adapting intensified regimens to cure pediatric Burkitt lymphoma in Africa

Pediatric lymphoma patients in Malawi present with poor health‐related quality of life at diagnosis and improve throughout treatment and follow‐up across all Pediatric PROMIS‐25 domains

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