Effect of a Malaria Suppression Program on the Incidence of African Burkitt's Lymphoma

Abstract

From 1977 to 1982, the authors attempted a malaria suppression trial in North Mara District, Tanzania, to see whether the incidence of Burkitt's lymphoma (BL) could be lowered by reducing the level of malarial infection in a child population below 10 years of age. Immediately after initiation of the suppression trial, the prevalence of malaria fell drastically in the Mara children; however, soon after, the rate of malarial infection rose again in the trial area in spite of continued chloroquine distribution, and by 1981 the prevalence of malarial infection again reached the high levels that had prevailed in the North Mara lowlands before 1977. However, during the period of chloroquine distribution in North Mara, the level of malarial infection there was constantly lower than that observed in a comparison area in South Mara, although the two areas had been similar with respect to malaria endemicity prior to the intervention. During the years of chloroquine distribution in North Mara, the incidence rate of BL there fell considerably, from about 4 per 100,000 population to about 1 per 100,000 population, and it rose again to pretrial levels in 1984, that is, about two years after the chloroquine distribution had been terminated. This apparent association between malaria suppression and decline in BL incidence at first seemed to indicate that malaria is a causal factor in BL production. A close scrutiny of the survey data revealed, however, that the decline in BL incidence might have started several years before the chloroquine distribution began; thus it appears that the malaria suppression could not have been the sole cause of the BL decline.

Targeting lysosomal degradation induces p53-dependent cell death and prevents cancer in mouse models of lymphomagenesis

“…Intriguingly, an epidemiologic trial supports this notion. Specifically, in an attempt to investigate whether malaria was a causative agent in the high incidence of Burkitt lymphoma in equatorial Africa, a trial was performed in which CQ was provided to a large section of the country of Tanzania for 5 years, with instructions for children to take 1 dose every 2 weeks (45). During the time period of the study, the incidence of endemic Burkitt lymphoma in the region decreased by approximately 75%, and the tumor incidence then returned to the old baseline within 2 years after completion of the trial.…”

African Burkitt Lymphoma: Age-Specific Risk and Correlations with Malaria Biomarkers

“…22 Data from Tanzania were obtained from Shirati Hospital for cases in persons from the North Mara region who were diagnosed and treated during 1960-2009. 23 Completeness of these series is uncertain, but they were thought to be representative of the cases from the regions served by the hospitals.…”

Spatial clustering of endemic Burkitt's lymphoma in high‐risk regions of Kenya

“…Similar case demographics between our study and others support this assertion; the median disease onset age (7.0 years), approximate equal gender ratio and similar ethnic distribution (93% Luo) in our study were also consistent with those from other studies in Kenya and a follow-up study in Northern Tanzania. 15,20 The exception may be for the year 2002 when treatment was not available and for the few cases for which residence information at the 4th administrative level was not available. Our conclusions, therefore, assume a similar geographic distribution for undiagnosed eBL cases which may have occurred during 2002 and for cases without high resolution residence information.…”