Results of treatment with CMA, a low intermediate regimen, in endemic Burkitt lymphomas in sub-Saharian Africa: experience of Côte d’Ivoire

Abstract

African Burkitt lymphomas (BL) are highly aggressive lymphomas mainly affecting children and young adults in Africa. This lymphoma was marked by its high sensitivity to chemotherapy in comparison to Sporadic Burkitt lymphoma. In this study, we evaluated the treatment response and survival of patients with CMA protocol. Eighty-five of the 105 children registered were evaluated for response; there were 46 boys and 39 girls, whose age at diagnosis ranged from 3 to 18 years (median 11 years), admitted to the Hematology National Teaching Hospital of Abidjan in the period 1998-2008 with a diagnosis of BL on histological review and who were given CMA chemotherapy with curative intent are included in this analysis. CMA protocol is a low intermediate regimen of 3 drugs [Cytarabin (ara-C), Methotrexate (MTX), and Cyclophosphamide] with CNS-directed treatment by intrathecal MTX, ara-C and corticosteroid. Fifty-five of 85 patients obtained CR after induction therapy and 10 after 3 supplementary cycle because of partial response. The overall complete remission was 76%. Fifty-three of patients were alive in first CR at a median survival rate period of 2 years (range 82 days to 9 years) and are continuously disease free from Burkitt lymphomas. Twelve patients relapse after CR and died of lymphoma progression. More than 32 patients died, as a result of lymphoma progression. Among the 32 dead, 10 were in Murphy stage IV and all the patients who presented bone marrow involvement died. The projected 5-year overall survival rate was 62%. In conclusion, CMA protocol shows the high sensitivity of African Burkitt lymphoma. This can be considered as a successful result for people living in poor socio-economic conditions with no health insurance.

Treatment of Burkitt lymphoma in equatorial Africa using a simple three‐drug combination followed by a salvage regimen for patients with persistent or recurrent disease

“…While combination therapy of the type used in protocol INCTR 03‐06 is more expensive than monotherapy with CTX, the overall survival of 67% at 1 year and 62% at 2 years (relapse is rare after disease‐free survival of a year), especially in the context of a number of potentially avoidable deaths (e.g., due to poor management of tumour lysis syndrome in one centre) appears to be superior to the earlier results achieved with CTX alone (Kazembe et al , ; Hesseling et al , ). They are similar to recent results reported from Abidjan of therapy involving CTX, Ara‐C and MTX (Koffi et al , ) and to results from Cameroon using higher dose CTX and IT MTX followed by stage and response‐specific therapy (Hesseling et al , ). The published literature is consistent with the idea that combination therapy is superior in African BL to the use of CTX as the sole systemic drug (Magrath, ), although the randomized trial in which this was examined was carried out prior to the development of effective CNS prophylaxis and involved very small numbers (Olweny et al , ).…”

Factors influencing survival among Kenyan children diagnosed with endemic Burkitt lymphoma between 2003 and 2011: A historical cohort study

“…Independent of chemotherapy dosing, having more advanced disease was associated with worse survival, as previously demonstrated . Tumor stage at diagnosis, however, was slightly different in our study population compared to other recent studies, with the majority presenting with abdominal tumors . This difference could be due to improved ascertainment of abdominal tumors or earlier recognition of cancer as a diagnosis.…”

“…24,29 Tumor stage at diagnosis, however, was slightly different in our study population compared to other recent studies, with the majority presenting with abdominal tumors. 8,10,24,25,28,30 This difference could be due to improved ascertainment of abdominal tumors or earlier recognition of cancer as a diagnosis. While incomplete medical charts and more comprehensive tumor staging methods were a limitation, the long term follow-up data available suggest that eBL outcomes at JOOTRH compare with recent studies complied from similar resource-limited settings.…”

Childhood cancer in Africa

“…Published data from African collaborative studies are scarce and overall survival rates varied from 5% to 80% . Most reports are from single‐unit treatment centres and the majority reported the outcomes for BL , nephroblastoma , and retinoblastoma . The Franco‐African Childhood Cancer Group (GFAOP) is the first collaborative group in Africa, founded in 2000, with the aim of providing paediatric cancer treatment .…”