Developing a Model of Care for BL in Equatorial Africa

Program: Pediatric Oncology
Coordinators: Ian Magrath and Melissa Adde
Other INCTR Participants: Sidnei Epelman, Lorenzo Leoncini, Emma Seaford, Nick Seaford, Valeria Calbi
Collaborators: St Mary's Hospital Lacor, Gulu, Uganda, Dr Martin Ogwang and Bugando Medical Centre, Mwanza, Tanzania, Dr Nestory Masalu
Branch(es): INCTR & INCTR Brasil
Location: Single Continent
Country(s): Uganda and Tanzania
Institutions: St Mary's Hospital Lacor, Gulu, Uganda and Bugando Medical Centre, Mwanza, Tanzania
Background Information: This study has been in progress since 2004. It is structured as a case series that can be used in Africa and countries at a similar level of development anywhere in the world. The participating hospitals have been entered sequentially and their treatment will be changed to ensure that all patients receive all drugs
Objectives: 1. To improve the outcome of patients with Burkitt lymphoma in Africa by a combination of improved care, more rapid transportation to hospitals able to deliver the care and to educate primary care physicians and the public about the signs of cancer
2. To establish a means of accommodation for the families of patients with Burkitt lymphoma, who are generally poor patients who may not even be able to provide the bus fare
3. To combine, in an alternating fashion, the two types of cycle of chemotherapy drugs that have been used to treat first new patients, then patients with recurrent disease.
Methods: Sequential patients with Burkitt lymphoma will be undertaken with additional drugs in patients with more limited disease because of early detection, made possible by education of the public and primary care providers and to the extent possible, improved communications between the location of the diagnosis being suspected and the treatment center.
Progress: Over 800 patients have been treated with a mean overall survival of 62%. For Africa, this is an excellent result, although it is important to note that it is an average result (the last series, treated at Lacor Hospital in Uganda achieved a long term surivival of 80%. This suggests that the use of all of the drugs in all except patients with minimal disease (stage 1), a better result is achieved when more drugs are given. Note, however, that this is an alternating regimen, each of the drug combinations being given separately rather than simultaneously, since the latter would result in considerable toxicity.

The improved results are likely to be due to the fact that now all except patients with minimal disease will receive all drugs. At present, the standard COM regimen is being used at Lahore. The full COM-IVAC protocol should be initiated this year.
Future Plans: Attempts will continue to be made to increase survival and reduce toxicity in patients with Burkitt lymphoma by education and training of the public, and development of a standard such that the treatment to continue to improve over time as diagnosis, treatment, surveillance and edication of the public continues.
Duration: indefinate
Publications: British Journal of Cancer
Month: 01
Year: 2016
Last Update: 12/2016
Document: Continuing to improve treatment of Burkitt lymphoma.

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