KCH Lymphoma Study Burkitt Database

Published: 26-01-2019| Version 1 | DOI: 10.17632/d857z43fjr.1
Contributor:
Matthew Painschab

Description

Database of prospective cohort of Burkitt lymphoma patients at Kamuzu Central Hospital, Lilongwe, Malawi. Manuscript published in Blood Advances; Painschab, et al., 2019. ABSTRACT Burkitt lymphoma (BL) is common in sub-Saharan Africa (SSA). In high-income countries, BL is highly curable with chemotherapy. However, there are few prospective studies from SSA describing non-pediatric BL and no regional standard of care. Thirty-five participants aged ≥15 years with newly diagnosed BL from 2013-2018 in Malawi were enrolled. Chemotherapy was administered according to local institutional guidelines, with concurrent antiretroviral therapy (ART) if HIV-infected. Median age was 21 (range 15-61) and 15 (43%) participants were HIV-infected. Twenty-seven (77%) participants had stage III/IV disease and 19 (54%) had ECOG performance status (PS) >1. Among HIV-infected, median CD4 count was 130 (range 29-605), and ten (67%) had suppressed HIV viral load. Four (11%) patients died before chemotherapy initiation. First-line chemotherapy consisted of CHOP in 22 (71%), infusional EPOCH in four (13%), high-dose methotrexate-based chemotherapy in four (13%), and rituximab+CHOP in one (3%). Among 28 evaluable participants, fourteen (50%) achieved a complete response and six (21%) achieved a partial response. Median overall survival (OS) was seven months; one-year OS was 40% (95% CI 24-56%). 16/22 (73%) deaths were from disease progression. Death was associated with worse PS, lower BMI, higher stage, higher LDH, and higher creatinine. Compared with CHOP, more intensive chemotherapy was associated with decreased mortality (HR 0.24 [0.05-1.02], p=0.05). This is among the best characterized prospective cohorts of non-pediatric BL in SSA. Most deaths resulted from progressive BL. Patients who received more intensive therapy appeared to have better outcomes. Defining optimal approaches is an urgent priority in SSA. 

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