[Burkitt's lymphoma in children of Madagascar. Anatomo-clinical forms, therapeutic and evolutive aspects]

Burkitt Lymphoma (LB), a very progressive malignant lymphoma, can now be cured by chemotherapy. However, protocols used currently by developed countries are costly and can cause problems of tolerance for underprivileged children.

To develop a protocol of care for Malagasy children suffering from LB.

A retrospective study of the files of children aged under 15 aged years, hospitalised for LB with anatomo-pathological evidence, in the Antananarivo Oncology Unit from October 1985 to June 2000. Clinical characteristics, (paraclinical) investigations, treatment and responses to treatment were studied.

40 medical records included a LB anatomo-pathological evidence. The mean age of children was 7.5 years, with a sex ratio in favour of males. All children were underweight. Maxillo-facial tumours prevailed. Other locations for tumours had also been observed, both unique or immediately multiple. Patients seem to have arrived at the hospital in the early stages of the disease, but lack of investigation probably introduced biases to the evaluation of these stages. Chemotherapy, even though incomplete due to its cost, remained the main means of treatment. Generally speaking, an immediate, favourable response was obtained, but the toxicity of chemotherapy, especially haematological toxicity, contributed to malnutrition. Overall results indicated an immediate mortality rate of 22.5%, but there was loss of follow-up for many patients.

A specific protocol of LB care in Madagascar appears to be possible. Such a protocol should be based on experience with treatments, and should take into account disease characteristics, the response of Malagasy children to the treatment, as well as the country's economic state.