Finding an optimal treatment regimen for endemic Burkitt's lymphoma in a limited resource setting: A historical comparison of an INCTR-03-06 protocol for children treated at a tertiary pediatric oncology unit in Tanzania.

Abstract

e22507 Background: Adoption of intensive chemotherapy for endemic Burkitt lymphoma (eBL) in low income settings such as the French LMB-protocol with survival rates over 90% is limited by unavailability of quality supportive care for treatment related toxicity. Late stage at diagnosis and comorbidities such as HIV, Malnutrition and other socioeconomic challenges complicate this quagmire. Review the nonclinical trial setting performance of a three-drug regimen previously reported by the INCTR-03-06 study among children treated for eBL from 2012 to 2017 at a National Hospital in Dar es Salaam Tanzania. Methods: Medical record review of children treated for eBL to document demographic, clinical, chemotherapy regimen and outcome was conducted followed by phone call structured interviews for current survival status. Overall survival (OS) and Event Free Survival (EFS) were determined by Kaplan-Meier method and survival differences compared using the Log-rank test. Cox regression analysis was used to relate variables with mortality. Data analysis was done by SPSS version 20 and p-value of < 0.05 considered statistically significant. Results: Out of the 123 children enrolled, male to female ratio was 1.6:1, median age 7 years (IQR 4 -10). Abdominal disease was the commonest presentation, 39% (48/123) and 25.2% (31/123) jaw mass. On phone call interviews 39.84% (49/123) of the children were in remission, 33.33%(41/123) died while 26.83% (33/123) were lost to follow up. Complete tumor response was achieved in 55.9% (62/111) of children treated on 1st line chemotherapy. Overall Survival rates (OS) at 12 and 18 months were 63.4% and 54% respectively while Event-Free Survival (EFS) were 38.8% and 36.4% respectively. HIV infected children (aHR 5.12 95% CI 1.39- 19.0; log-rank P< 0.01). and those with advanced disease at diagnosis( aHR2.34 95% CI 1.09-5.05 P < 0.03) were at high risk of death. Conclusions: Contrary to prior understanding of eBL as a predominantly jaw disease, abdominal site is increasingly reported likely due to widespread use of sensitive imaging modalities. In line with other studies in low- and middle-income countries, few children with eBL achieve complete remission using low intensity chemotherapy regimens calling for more studies for safe and feasible regimens to be used as efforts to improve supportive care continue. HIV infected children with eBL and those with advanced disease at diagnosis should be considered at high risk of mortality.