Malnutrition and neutropenia in children treated for Burkitt lymphoma in Malawi

Israëls, Trijn; Wetering, Marianne D. van de; Hesseling, Peter; Geloven, Nan van; Caron, Huib N.; Molyneux, Elizabeth

doi:10.1002/pbc.22032

Cited by 88 publications

(91 citation statements)

References 26 publications

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“…77,78 No studies systematically investigate causes of febrile neutropenia in subSaharan Africa, although febrile neutropenia occurs in more than 80% of patients with hematologic malignancies in developed countries, 79 and frequently complicates treatment of children in Malawi and South Africa. 80,81 Available intravenous antibacterial agents include penicillin, ampicillin, cloxacillin, ceftriaxone, chloramphenicol, ciprofloxacin, gentamicin, metronidazole, and sulfamethoxazole-trimethoprim. 64 Vancomycin, ceftazidime, and imipenem, agents that are more typically used for empiric treatment of febrile neutropenia in developed countries, are WHO complementary rather than core medicines and not typically available.…”

Section: Supportive Care and Palliationmentioning

confidence: 99%

Meeting the challenge of hematologic malignancies in sub-Saharan Africa

Gopal

Wood

Lee

et al. 2012

Blood

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Cancer is a leading cause of death and disability in sub-Saharan Africa and will eclipse infectious diseases within the next several decades if current trends continue. Hematologic malignancies, including non-Hodgkin lymphoma, leukemia, Hodgkin lymphoma, and multiple myeloma, account for nearly 10% of the overall cancer burden in the region, and the incidence of non-Hodgkin lymphoma and Hodgkin lymphoma is rapidly increasing as a result of HIV. Despite an increasing burden, mechanisms for diagnosing, treating, and palliating malignant hematologic disorders are inadequate. In this review, we describe the scope of the problem, including the impact of endemic infections, such as HIV, Epstein-Barr virus, malaria, and Kaposi sarcoma–associated herpesvirus. We additionally describe current limitations in hematopathology, chemotherapy, radiotherapy, hematopoietic stem cell transplantation, and supportive care and palliation. We review contemporary treatment and outcomes of hematologic malignancies in the region and outline a clinical service and research agenda, which builds on recent global health successes combating HIV and other infectious diseases. Achieving similar progress against hematologic cancers in sub-Saharan Africa will require the sustained collaboration and advocacy of the entire global cancer community.

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Section: Supportive Care and Palliationmentioning

confidence: 99%

Meeting the challenge of hematologic malignancies in sub-Saharan Africa

Gopal

Wood

Lee

et al. 2012

Blood

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“…About half of the Malawian patients in a previous study were severely, acutely malnourished [4,5]. Malnutrition reduces immunity to infections and in patients with Burkitt lymphoma is associated with more severe chemotherapy-related toxicity, especially neutropenia [6][7][8]. Not all aspects of supportive care available in high-income countries are available to children in Malawi and so it is essential to balance intensity of treatment with these factors to avoid unacceptable treatment-related morbidity and mortality.…”

Section: Introductionmentioning

confidence: 99%

The efficacy and toxicity of SIOP preoperative chemotherapy in Malawian children with a Wilms tumour

Israëls

Chagaluka

Pidini

et al. 2012

Pediatric Blood & Cancer

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BackgroundIn Malawi, preoperative chemotherapy for Wilms tumour is a logical strategy, but detailed information on toxicity and efficacy in such a resource limited setting has been unavailable.ProcedurePatients diagnosed with a unilateral Wilms tumour received preoperative chemotherapy—a two‐drug 4‐week regimen for localized disease and 6 weeks of a three‐drug regimen for metastatic disease. Estimated maximum tumour diameter, decrease in tumour size, resectability, stage distribution and haematological toxicity during therapy were documented.ResultsAt diagnosis, 28% of 72 patients had an estimated maximum tumour diameter of more than 25 cm; 29% of patients had metastases. Eight children (11%) died during preoperative chemotherapy. More than half (59%) of the patients developed moderate neutropenia (neutrophils <1.0 × 109/L; CTC grade 3) and 27% severe neutropenia (CTC grade 4 neutrophils <0.5 × 10.9/L). Grade 4 neutropenia occurred significantly more frequently in children receiving the three‐drug regimen compared to the two‐drug regimen; 50% (10/20) versus 15% (6/40) (P = 0.004). Fifty‐seven percent of all patients had CTC grade 4 anaemia (Hb < 6.5 g/dL) during treatment. Most tumours (92%, 56/61) showed a response to chemotherapy but 14% (8/58) remained unresectable.ConclusionPreoperative chemotherapy for Wilms tumour causes considerable haematological toxicity and treatment‐related mortality in malnourished Malawian children. A significant number of children have unresectable disease despite preoperative chemotherapy. To reduce treatment related mortality, consideration should be given to starting treatment with reduced doses in acutely malnourished patients. Pediatr Blood Cancer 2012;59:636–641. © 2012 Wiley Periodicals, Inc.

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“…Patients with abdominal BL are usually more malnourished than patients with Wilms tumour [16,17]. Patients with BL often have masses elsewhere and tumour growth is fast.…”

Section: Diagnosis and Differential Diagnosis: Diagnostic Facilities;mentioning

confidence: 99%

“…Patients are often severely and acutely malnourished at presentation and this is associated with more severe chemotherapy-associated toxicity [17,30,31]. Infectious complications are the most common cause of treatment-related mortality in low income countries [8].…”

Section: Supportive Carementioning

confidence: 99%

SIOP PODC: Clinical guidelines for the management of children with Wilms tumour in a low income setting

Israëls

Moreira

Scanlan

et al. 2012

Pediatric Blood & Cancer

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Wilms tumour is a relatively common and curable paediatric tumour. Known challenges to cure in low income countries are late presentation with advanced disease, malnutrition, failure to complete treatment and limited facilities. In this article, management recommendations are given for a low income setting where only the minimal requirements for treatment with curative intent are available (setting 1). These include general management, supportive care, social support and registration of patients. Recommendations specific for Wilms tumour care include diagnostic procedures with emphasis on the role of ultrasonography, preoperative chemotherapy with a reduced dosage for malnourished children and postoperative chemotherapy based on surgical staging. Pediatr Blood Cancer 2013; 60: 5–11. © 2012 Wiley Periodicals, Inc.

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Malnutrition and neutropenia in children treated for Burkitt lymphoma in Malawi

Cited by 88 publications

References 26 publications

Meeting the challenge of hematologic malignancies in sub-Saharan Africa

Meeting the challenge of hematologic malignancies in sub-Saharan Africa

The efficacy and toxicity of SIOP preoperative chemotherapy in Malawian children with a Wilms tumour

SIOP PODC: Clinical guidelines for the management of children with Wilms tumour in a low income setting

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