Treating Burkitt's lymphoma in Malawi, Cameroon, and Ghana

Hesseling, Peter; Molyneux, Elizabeth; Tchintseme, Francine; Welbeck, J; McCormick, Peter; Pritchard‐Jones, Kathy; Wagner, Hans-Peter

doi:10.1016/s1470-2045(08)70139-6

Cited by 39 publications

(30 citation statements)

References 5 publications

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“…The 1-year survival rate for nephroblastoma in this study was 27.1%. The cost of treatment for both cancers is also relatively low compared with that of treating other malignancies: BL treatment costs around US$50 9 and the cost of treating stage 2 -3 nephroblastoma, without radiotherapy, amounts to US$699. 10 Other countries from sub-Saharan Africa report a distribution of malignant pathology in children similar to that described in this study.…”

Section: Discussionmentioning

confidence: 99%

Childhood cancer in Côte d’Ivoire, 1995 - 2004 – challenges and hopes

et al. 2012

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Background. There is insufficient research into the state of paediatric oncology in African countries. Objectives. The purpose of this study was to analyse the state of paediatric oncology between 1995 and 2004 in Côte d'Ivoire. Methods. This retrospective descriptive study analysed all patients under the age of 18 who were diagnosed with cancer in Côte d'Ivoire over a period of 10 years (January 1995 -December 2004) with regard to demographics, types of pathology, delay in diagnosis and treatment, treatment modalities, abandonment of treatment and survival rate. Results. Of 405 patients diagnosed with cancer, 331 were included in the study. Burkitt's lymphoma was the most common malignancy (73.6%), followed by nephroblastoma (14.5%) and acute leukaemia (4%). Delay in diagnosis occurred in 38.7% of cases and ranged from 1 to 3 months; the average delay from diagnosis to starting treatment was 18 days. An abdominal mass and swelling of the jaw were the most common clinical presentations. Almost half of the patients (48.6%) were lost to follow-up and over a third (39.3%) died shortly after admission owing to advanced disease. The overall survival rate was 9.4%. Conclusions. Cancer in children in Côte d'Ivoire was dominated by Burkitt's lymphoma. The rate of loss to follow-up of almost 50% is grounds for concern. The overall survival rate of 9.4% is very low, but such figures are not uncommon for African countries. Collaboration within the Franco-African Group of Paediatric Oncology has contributed to improving the management of children with cancer.

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Section: Discussionmentioning

confidence: 99%

Childhood cancer in Côte d’Ivoire, 1995 - 2004 – challenges and hopes

et al. 2012

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“…The clinical and biologic features and outcomes of mature B‐cell neoplasms are not uniform worldwide . For example, the survival rates for endemic Burkitt lymphoma are substantially lower than those for sporadic Burkitt lymphoma . The reasons for these differences are unknown, but they are probably related to access to optimal care rather than to the disease biology.…”

Section: Introductionmentioning

confidence: 99%

Outcome of pediatric non‐Hodgkin lymphoma in Central America: A report of the Association of Pediatric Hematology Oncology of Central America (AHOPCA)

Peña‐Hernandez

Ortiz

Garrido

et al. 2019

Pediatric Blood & Cancer

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Background Treating B–non‐Hodgkin lymphoma (B‐NHL) in lower‐income countries is challenging because of imprecise diagnosis, the increased risk of fatal toxicity associated with advanced disease at presentation, and limited supportive care. Procedure Central American patients with newly diagnosed stage I or II B‐NHL received a modified Berlin–Frankfurt–Münster (BFM) regimen including a prephase (prednisone, cyclophosphamide) followed by A/B/A courses (A: cytarabine, dexamethasone, etoposide, ifosfamide, methotrexate, and intrathecal therapy; B: cyclophosphamide, dexamethasone, doxorubicin, methotrexate, and intrathecal therapy). Those with stage III or IV NHL received additional courses (B/A/B), intensified for stage IV disease by additional vincristine and methotrexate doses. Patients in poor condition received a second prephase treatment before their chemotherapy courses. Results Between March 2004 and June 2016, of 405 patients with B‐NHL, 386 (109 females) were eligible for treatment. Immunohistochemistry was performed in 177 cases (47.4%) and characterized the disease as mature B‐cell lymphoma. Stage distribution was as follows: I/II, 31 (8.1%); III, 252 (65.3%); IV, 93 (24.1%); 10 (2.6%) not available. The 3‐year overall survival was 70% for the whole group (86% for stages I/II, 75% for stage III, 58% for stage IV). Events included death during induction (34 patients, 8.8%), relapse/progression (46, 11.9%), death in remission (9, 2.3%), second malignancy (1, 0.26%), and death of unknown cause (1, 0.26%). Twenty‐three (6%) patients abandoned or refused therapy. Conclusions Approximately 70% of children with B‐NHL from Central America experienced long‐term, disease‐free survival with a modified BFM schedule. Toxic death and relapse/resistant disease were the main reasons for treatment failure.

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“…[22] On the other hand, published reports of chemotherapy trials in children with endemic BL have emerged, are informative, and have clearly identified the challenges in administering dose-intense chemotherapy in other clinical settings in sub-Saharan Africa [e.g., Malawi and International Society of Paediatric Oncology (SIOP) network], where 1-year event-free survival is 57% and treatment related mortality is on the order of 30%, which contrasts with at 90% 1-year EFS rate in Europe and markedly diminished treatment related mortality attributable to the requisite supportive care in the resource-rich environment to sustain children through prolonged periods of dose-intense myelosuppression. [53-55] This experience in children, perhaps more than any other, substantiates the challenges of administering myelosuppressive chemotherapy in settings where resources are scarce and readily translates into the clinical management of patients with AR-NHL. Treatment mortality rates in other disease settings but especially BL, when published, have ranged between 20-66% in other studies, which is unacceptable in the resource-rich setting.…”

Section: Current Evidence For Treatment Of Aids-related Nhl In Sub-samentioning

confidence: 84%

AIDS-Related Non-Hodgkin's Lymphoma in Sub-Saharan Africa: Current Status and Realities of Therapeutic Approach

et al. 2012

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Today AIDS-related non-Hodgkin's lymphoma (AR-NHL) is a significant cause of morbidity and mortality in HIV-infected patients the world over, and especially in sub-Saharan Africa. While the overall incidence of AR-NHL since the emergence of combination antiretroviral therapy (cART) era has declined, the occurrence of this disease appears to have stabilized. In regions where access to cART is challenging, the impact on disease incidence is less clear. In the resource-rich environment it is clinically recognized that it is no longer appropriate to consider AR-NHL as a single disease entity and rather treatment of AIDS lymphoma needs to be tailored to lymphoma subtype. While intensive therapeutic strategies in the resource-rich world are clearly improving outcome, in AIDS epicenters of the world and especially in sub-Saharan Africa there is a paucity of data on treatment and outcomes. In fact, only one prospective study of dose-modified oral chemotherapy and limited retrospective studies with sufficient details provide a window into the natural history and clinical management of this disease. The scarcities and challenges of treatment in this setting provide a backdrop to review the current status and realities of the therapeutic approach to AR-NHL in sub-Saharan Africa. More pragmatic and risk-adapted therapeutic approaches are needed.

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Treating Burkitt's lymphoma in Malawi, Cameroon, and Ghana

Cited by 39 publications

References 5 publications

Childhood cancer in Côte d’Ivoire, 1995 - 2004 – challenges and hopes

Childhood cancer in Côte d’Ivoire, 1995 - 2004 – challenges and hopes

Outcome of pediatric non‐Hodgkin lymphoma in Central America: A report of the Association of Pediatric Hematology Oncology of Central America (AHOPCA)

AIDS-Related Non-Hodgkin's Lymphoma in Sub-Saharan Africa: Current Status and Realities of Therapeutic Approach

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