Experience with B-cell lymphoma at a South African centre in the HIV Era

In South Africa most cases of Burkitt lymphoma (BL) are sporadic, and constituted the majority of paediatric B-cell lymphomas (BCL) prior to the HIV epidemic. The purpose of the study was to review the results for HIV-negative children with BCL, to assess the effect of HIV-AIDS and to determine the optimum treatment for HIV-positive children.

The study was a retrospective folder review of patients with BCL at Red Cross Children's Hospital between 1991 and 2011.

One hundred and fourteen patients with BCL were diagnosed; 98 with BL, 14 with Diffuse Large B-cell lymphoma (DLBCL) and two with other forms of BCL. The proportion of DLBCL was 6.5% among HIV-negative and 36.4% among HIV-positive patients. Ninety-one HIV-negative patients were treated with LMB-based regimens. Event free survival (EFS) was 79%, with EFS for Groups A, B and C of 100%, 82.5% and 67.5%. Twenty-two HIV-positive patients were diagnosed since 2003, increasing the average number of cases from 4.3 per year to 6.9 per year. All had access to anti-retrovirals and 15 were treated with curative intent. EFS for the whole group was 58.4%. Since 2009 we have used LMB-based regimens achieving complete remission in six patients without excessive toxicity.

Results for HIV-negative patients are acceptable, but there is a need to improve outcomes for patients with combined bone marrow and CNS disease. HIV-AIDS has increased the number of BCLs with a higher proportion of DLBCL, and portends a poorer prognosis. Early evidence suggests we can achieve comparable outcomes without excessive toxicity by employing LMB-based regimens.