Conflict of interest: Nothing to declare.
Cyclophosphamide monotherapy in children with Burkitt lymphoma: A study from the French–African Pediatric Oncology Group (GFAOP)†
Article first published online: 5 NOV 2010
Copyright © 2010 Wiley-Liss, Inc.
Pediatric Blood & Cancer
Volume 56, Issue 1, pages 70–76, January 2011
How to Cite
Traoré, F., Coze, C., Atteby, J.-J., André, N., Moreira, C., Doumbe, P., Ravelomanana, N., Ye, D., Patte, C., Raquin, M.-A., Raphael, M. and Lemerle, J. (2011), Cyclophosphamide monotherapy in children with Burkitt lymphoma: A study from the French–African Pediatric Oncology Group (GFAOP). Pediatr. Blood Cancer, 56: 70–76. doi: 10.1002/pbc.22746
- Issue published online: 24 NOV 2010
- Article first published online: 5 NOV 2010
- Manuscript Accepted: 15 JUN 2010
- Manuscript Received: 22 OCT 2009
- Burkitt lymphoma;
- non-Hodgkin lymphoma;
- sub-saharan Africa
The French African Group of Pediatric Oncology was set-up to improve quality of care for children with cancer. Preliminary observations on the efficacy in Burkitt lymphoma (BL) of a cyclophosphamide monotherapy (CPM) have been published. We report the results of a multicentric prospective study combining first-line CPM and a multidrug second-line chemotherapy (SC) for refractory/relapsed patients.
Patients ≤18 years with Burkitt or Burkitt-like lymphoma, were included in six countries (Burkina-Faso, Cameroon, Ivory Coast, Madagascar, Mali, and Senegal). All patients received three weekly CPM courses (1.2 g/m2 IV with intrathecal methotrexate and hydrocortisone), stage 3/4 patients received three further courses. SC added methotrexate, vincristine, cytarabine, and prednisone.
There were 178 patients included (42 stage 1/2, 134 stage 3/4, and 2 unknown). Isolated facial localization was found in 41 patients, diffuse abdominal involvement in 120 patients including 65 with both. Nine early deaths were reported, toxicity occurred in 136/743 courses (83 patients) and was predominantly hematological. After CPM, complete remission (CR) rate was 47% with a 33% EFS. Because of rapid progression 76/108 eligible patients (85 primary refractory and 23 relapses) received SC resulting in 35.7% CR but a 21% toxic death rate. The OS of the whole strategy was 50.5% and correlated to stage.
A prospective multicentric study on BL was feasible in very low-income countries. CPM can be recommended in stage 1–2 because of optimal cost/benefit ratio. However, more intensive strategies, still adapted to socio-economic conditions, are required for advanced stages 3 and 4. Pediatr Blood Cancer. 2010;56:70–76. © 2010 Wiley-Liss, Inc.