Treatment of Burkitt's lymphoma: the African experience

Although Burkitt's lymphoma (BL) can be treated by surgery, radiotherapy and immunotherapy, chemotherapy is the mainstay of treatment. This paper summarizes the various clinical trials undertaken in Africa over the past decade. The single most effective drug for BL is cyclophosphamide (CPM). Given alone for remission induction, CPM is as effective as combinations consisting of either CPM, vincristine (VCR) and methotrexate (MTX) or CPM, VCR and cytosine arabinoside (Ara-C). Survival data indicate that single-dose CPM is comparable to multiple doses. Thus, maintenance therapy may not be necessary, and may in fact worsen the final outcome. Intrathecal (IT) MTX given together with systemic therapy significantly delays central nervous system (CNS) relapse, which is not prevented by cerebrospinal irradiation. For established CNS disease, IT-Ara-C for three days followed by MTX on the fourth day is effective. Bacillus Calmette-Guérin scarification, while provoking measurable responses in vivo and in vitro, had no measurable, specific anti-tumour reaction, since no effect was observed on relapse rate, duration of remission or survival. High-dose CPM produces objective responses in patients previously resistant to conventional doses. Teniposide (VM 26) is currently undergoing phase 2 trial, and definite short-lived responses have been recorded.