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Outcomes for paediatric Burkitt lymphoma treated with anthracycline-based therapy in Malawi
Christopher C Stanley1, Kate D Westmoreland1, Brett J Heimlich1
1UNC Project-Malawi, Lilongwe, Malawi.
Insights
CHOP chemotherapy did not improve survival for children with Burkitt lymphoma in Malawi. This study found poor outcomes, highlighting the need for better pediatric cancer treatments in sub-Saharan Africa.
Area of Science:
- Pediatric Oncology
- Hematology
- Global Health
Background:
- Burkitt lymphoma (BL) is the most common pediatric cancer in sub-Saharan Africa (SSA).
- Anthracycline-based chemotherapy, like CHOP, is standard in resource-rich settings but understudied in SSA.
- Limited data exists on the efficacy of standard chemotherapy regimens for pediatric BL in SSA.
Purpose of the Study:
- To evaluate the outcomes of CHOP chemotherapy in children with newly diagnosed Burkitt lymphoma in Malawi.
- To assess survival rates and identify prognostic factors for pediatric BL treated with CHOP in a SSA setting.
Main Methods:
- Prospective enrollment of 73 children (≤18 years) with newly diagnosed BL from June 2013 to May 2015 in Malawi.
- Standardized staging, supportive care, and six cycles of CHOP chemotherapy (cyclophosphamide, doxorubicin, vincristine, prednisone).
- Analysis of survival data and associated risk factors including age, gender, disease stage, LDH, albumin, and performance status.
Main Results:
- Eighteen-month overall survival was low at 29% (95% CI 18-41%).
- Significant mortality predictors included older age (>9 years), female gender, advanced stage, elevated lactate dehydrogenase, and poorer performance status.
- High rates of grade 3/4 neutropenia (25%) and anemia (42%) were observed.
Conclusions:
- The standard CHOP regimen did not improve outcomes for pediatric Burkitt lymphoma in Malawi compared to less intensive treatments.
- There is a critical need for novel and more effective therapeutic strategies for pediatric BL in sub-Saharan Africa.
- Further research into optimized treatment protocols and supportive care is essential for improving survival rates in this vulnerable population.
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.
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