Cyclophosphamide monotherapy in children with Burkitt lymphoma: a study from the French-African Pediatric Oncology Group (GFAOP).

Abstract

BACKGROUND:

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.

PROCEDURE:

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/m(2) IV with intrathecal methotrexate and hydrocortisone), stage 3/4 patients received three further courses. SC added methotrexate, vincristine, cytarabine, and prednisone.

RESULTS:

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.

CONCLUSION:

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.

• Authors: Fousseyni Traoré, Carole Coze, Jean-Jacques Atteby, Nicolas André, Claude Moreira, Pierre Doumbe, Noeline Ravelomanana, Diarra Ye, Catherine Patte, Marie-Anne Raquin, Martine Raphael, Jean Lemerle
• Journal: Pediatric blood & cancer (Pediatr Blood Cancer) Vol. 56 Issue 1 Pg. 70-6 (Jan 2011) ISSN: 1545-5017 [Electronic] United States
• PMID: 21058286 (Publication Type: Clinical Trial, Journal Article, Multicenter Study)

Chemical References

• Antineoplastic Agents, Alkylating
• Cyclophosphamide

Topics

• Adolescent
• Antineoplastic Agents, Alkylating
• Burkitt Lymphoma (complications, drug therapy, mortality)
• Child
• Child, Preschool
• Cyclophosphamide (administration & dosage, toxicity)
• Developing Countries
• Disease-Free Survival
• Female
• Humans
• Infant
• Infant, Newborn
• Male
• Mali
• Neoplasm Staging
• Prospective Studies
• Remission Induction
• Salvage Therapy (methods)
• Survival Rate