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Burkitt's lymphoma treatment in a rural hospital in Sierra Leone
M San Roman1, F Aguilo, M Clapes
1St John of God Hospital, Mabesseneh, Sierra Leone.
Insights
A reduced-intensity chemotherapy protocol for pediatric Burkitt's lymphoma (BL) in Sierra Leone showed poor outcomes. Low-dose cyclophosphamide (CPM) was ineffective, with high relapse and refractory disease rates.
Area of Science:
- Pediatric Oncology
- Hematology
- Tropical Medicine
Background:
- Sierra Leone, located in the Burkitt's lymphoma (BL) endemic belt, faces challenges in pediatric cancer treatment.
- The study addresses the need for effective, accessible treatments for pediatric BL in low-income settings.
Purpose of the Study:
- To evaluate a reduced-intensity chemotherapy protocol for pediatric Burkitt's lymphoma (BL) in Sierra Leone.
- To assess the feasibility and effectiveness of cyclophosphamide (CPM)-based treatment in a resource-limited environment.
Main Methods:
- A prospective trial involving 87 children clinically diagnosed with BL between 2005 and 2008.
- Utilized a reduced-intensity cyclophosphamide (CPM) protocol, with treatment initiated based on clinical diagnosis.
- Diagnostic procedures like biopsy and staging were performed when feasible due to resource constraints.
Main Results:
- Most patients (82%) initially responded to treatment, but over half (54%) experienced relapse or refractory disease.
- A significant proportion of patients (46%) were lost to follow-up after achieving clinical response.
- Advanced disease at presentation and malnutrition were common among the pediatric participants.
Conclusions:
- The reduced-intensity cyclophosphamide (CPM) protocol demonstrated poor efficacy for pediatric Burkitt's lymphoma (BL) in rural Sierra Leone.
- Challenges including diagnostic limitations, advanced disease at presentation, and high patient drop-out rates contributed to the unfavorable outcomes.
- Alternative or intensified treatment strategies are needed for pediatric BL in this region.
Background:
Sierra Leone is a low-income sub-Saharan country in the endemic Burkitt's lymphoma (BL) belt. We performed a prospective trial of a reduced-intensity chemotherapy protocol for the treatment of paediatric BL.
Patients And Methods:
The trial included all children clinically diagnosed with BL between 2005 and 2008. Biopsy, bone-marrow aspiration, analysis of cerebrospinal fluid, abdominal ultrasound and plain x-ray of involved sites were performed when feasible. The treatment protocol was a first i.v. dose of cyclophosphamide (CPM) 40 mg/kg, followed by oral CPM weekly for two doses and then bimonthly to a total of six doses. Treatment was based on clinical diagnosis as it was several weeks before pathology results were available.
Results:
Eighty-seven patients were included, with a median age 7 years and 4 months; 59/87 (67.8%) were boys. Nearly half (n = 17, 42.5%), presented with moderate or severe malnutrition. Biopsy was performed in 44 patients, BL being verified in 36 (41.4% of all patients). Most children presented with advanced disease: 28 (32%) at stage II, 47 (54%) at stage III and 12 (13.8%) at stage IV. Most patients (71/87, 82%) initially responded to treatment, but just over half (47/87, 54%) experienced relapse and refractory disease. Forty patients (46%) in complete or partial clinical response were lost to follow-up.
Conclusion:
The outcome for BL in rural Sierra Leone according to this protocol is poor. Low-dose CPM was ineffective. Constraints on performing complete diagnosis and staging, frequency of advanced disease at presentation and a high drop-out rate might explain our poor results.
