Treating burkitt's lymphoma in Malawi, Cameroon, and Ghana.

Abstract

The Special Report: International published in the April issue of The Lancet Oncology, raised valid concerns about the issue of treating childhood Burkitt's lymphoma in Kenya and Uganda.1 These same concerns were voiced by delegates from 13 African countries at the first African Continental Conference of the International Society of Paediatric Oncology (SIOP) in Stellenbosch, South Africa, in 1994. At the end of this conference, a decision was made to develop effective and affordable treatment for African children with endemic Burkitt's lymphoma. At that time, over 90% event-free survival was being achieved in French children with sporadic Burkitt's lymphoma by use of short, but intensive, multidrug chemotherapeutic regimens adapted to initial tumour burden and response to chemotherapy.2 However, these Lymphome Malins de Burkitt (LMB) regimens included high doses of cyclophosphamide, doxorubicin, and methotrexate and needed a high level of supportive care. Thus, these regimens were clearly not feasible for the treatment of malnourished children with comorbidities in Africa. Hence, SIOP supported a study in Malawi, in which an overall 52% 1-year event-free survival was achieved for patients with St Jude stage I, II, or III endemic Burkitt's lymphoma, by use of a simplified LMB-like protocol. However, the cost of this treatment was too high and there were many toxic effects.3