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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
Author(s) -
Ngoma Twalib,
Adde Melissa,
Durosinmi Muheez,
Githang'a Jessie,
Aken'Ova Yetunde,
Kaijage Jane,
Adeodou Oluwagbemiga,
Rajab Jamilla,
Brown Biobele J.,
Leoncini Lorenzo,
Naresh Kikkeri,
Raphael Martine,
Hurwitz Nina,
Scanlan Patricia,
Rohatiner Ama,
Venzon David,
Magrath Ian
Publication year - 2012
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/j.1365-2141.2012.09236.x
Subject(s) - medicine , salvage therapy , vincristine , etoposide , mesna , ifosfamide , cytarabine , cyclophosphamide , surgery , regimen , oncology , gastroenterology , chemotherapy
Summary Prior to the introduction of the I nternational N etwork for C ancer T reatment and Research ( INCTR ) protocol INCTR 03‐06, survival of patients with B urkitt lymphoma at four tertiary care centres in equatorial A frica was probably no more than 10–20%. The results reported here for 356 patients have demonstrated marked improvement in survival through the use of a uniform treatment protocol consisting of cyclophosphamide, methotrexate, vincristine, and intrathecal therapy, and the introduction of non‐cross resistant second‐line (salvage) therapy, consisting of ifosfamide, mesna, etoposide and cytarabine, when patients failed to achieve a complete response to first‐line therapy or relapsed early. Overall survival rates of 67% and 62% were observed at 1 and 2 years (relapse is rare after 1 year of remission). Of interest was the small impact of cerebrospinal fluid ( CSF ) and bone marrow involvement on outcome. However, the presence or absence of abdominal involvement clearly defined two prognostic groups. An additional finding was the association between CSF pleocytosis and orbital tumours, suggesting that spread of tumour cells to the central nervous system may sometimes occur via direct involvement of cranial nerves in the orbit. Survival rates may be increased in patients with abdominal involvement by combining first‐ and second‐line therapy, but verification will require a further clinical study.