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Outcomes for paediatric Burkitt lymphoma treated with anthracycline‐based therapy in Malawi
Author(s) -
Stanley Christopher C.,
Westmoreland Kate D.,
Heimlich Brett J.,
ElMallawany Nader K.,
Wasswa Peter,
Mtete Idah,
Butia Mercy,
Itimu Salama,
Chasela Mary,
Mtunda Mary,
Chikasema Mary,
Makwakwa Victor,
Kaimila Bongani,
Kasonkanji Edwards,
Chimzimu Fred,
Kampani Coxcilly,
Dhungel Bal M.,
Krysiak Robert,
Montgomery Nathan D.,
Fedoriw Yuri,
Rosenberg Nora E.,
Liomba N. George,
Gopal Satish
Publication year - 2016
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/bjh.13986
Subject(s) - medicine , hazard ratio , vincristine , interquartile range , gastroenterology , neutropenia , chop , confidence interval , anthracycline , cyclophosphamide , surgery , pediatrics , lymphoma , chemotherapy , cancer , breast cancer
Abstract Burkitt lymphoma ( BL ) is the most common paediatric cancer in sub‐Saharan Africa ( SSA ). Anthracyline‐based treatment is standard in resource‐rich settings, but has not been described in SSA . Children ≤18 years of age with newly diagnosed BL were prospectively enrolled from June 2013 to May 2015 in Malawi. Staging and supportive care were standardized, as was treatment with CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) for six cycles. Among 73 children with BL , median age was 9·2 years (interquartile range 7·7–11·8), 48 (66%) were male and two were positive for human immunodeficiency virus. Twelve (16%) had stage I/ II disease, 36 (49%) stage III and 25 (34%) stage IV . Grade 3/4 neutropenia occurred in 17 (25%), and grade 3/4 anaemia in 29 (42%) of 69 evaluable children. Eighteen‐month overall survival was 29% (95% confidence interval [ CI ] 18–41%) overall. Mortality was associated with age >9 years [hazard ratio [ HR ] 2·13, 95% CI 1·15–3·94], female gender ( HR 2·12, 95% CI 1·12–4·03), stage ( HR 1·52 per unit, 95% CI 1·07–2·17), lactate dehydrogenase ( HR 1·03 per 100 iu/l, 95% CI 1·01–1·05), albumin ( HR 0·96 per g/l, 95% CI 0·93–0·99) and performance status ( HR 0·78 per 10‐point increase, 95% CI 0·69–0·89). CHOP did not improve outcomes in paediatric BL compared to less intensive regimens in Malawi.