Advanced Burkitt Lymphoma in Sub-Saharan Africa Pediatric Units: Results of the Third Prospective Multicenter Study of the Groupe Franco-Africain d'Oncologie Pediatrique
Advanced Burkitt Lymphoma in Sub-Saharan Africa Pediatric Units: Results of the Third Prospective Multicenter Study of the Groupe Franco-Africain d'Oncologie Pediatrique
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DOI：
10.1200/jgo.19.00172
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发表时间：
2019-12-03
影响因子：
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通讯作者：
Patte, Catherine
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文献类型：
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作者：
Bouda, Gabrielle C.;Traore, Fousseyni;Patte, Catherine
评估撒哈拉以南非洲儿科中心伯基特淋巴瘤（BL）强化综合化疗方案的结果患者和方法2009年4月至2015年9月期间，在7个中心前瞻性登记了使用GFAOP-Lymphomes Malins B（GFPMB）2009方案治疗的晚期BL（II期巨大、III期和IV期）儿童。治疗方案包括环磷酰胺前期，随后为2个诱导疗程（环磷酰胺、长春新碱、泼尼松、高剂量甲氨蝶呤[HDMTX]）、2个巩固疗程（阿糖胞苷，HDMTX）和仅针对IV期的维持期。HDMTX的剂量为3 g/m2。结果分析了400例患者：7%的患者为II期大体积，76%为III期，17%为IV期疾病。中位年龄为7.3岁，性别比为1.9：1（男性：女性）。共有221例患者接受了整个方案治疗，195例达到完全缓解（CR），其中11例在二线治疗后。放弃治疗率为22%。125例患者死亡，其中49例死亡与治疗毒性有关。共有275名患者存活，其中25名患者放弃治疗，但已知只有110名患者在随访中达到CR。1年，表明失访率较高。II期、III期和IV期的10个月总生存率（OS）分别为60%（95% CI，54%-66%）和63%、60%和31%。在34天内开始第二个诱导疗程的III期疾病患者的OS为76%，超过34天为57%（P = 0.0062）。早期治疗剂量强度是一个强有力的预后因素。改善支持性护理和减少失访至关重要。(C)2019年美国临床肿瘤学会
PURPOSE To evaluate the results of an intensive polychemotherapy regimen for Burkitt lymphoma (BL) in sub-Saharan African pediatric centers.PATIENTS AND METHODS Children with advanced-stage BL (stages II bulky, III, and IV) treated with the GFAOP-Lymphomes Malins B (GFALMB) 2009 protocol in 7 centers between April 2009 and September 2015 were prospectively registered. Treatment regimen contained a prephase with cyclophosphamide followed by 2 induction courses (cyclophosphamide, vincristine, prednisone, high-dose methotrexate [HDMTX]), 2 consolidation courses (cytarabine, HDMTX), and a maintenance phase only for stage IV. HDMTX was given at the dose of 3 g/m(2).RESULTS Four hundred patients were analyzed: 7% had stage II bulky, 76% stage III, and 17% stage IV disease. Median age was 7.3 years, and sex ratio was 1.9:1 (male:female). A total of 221 patients received the whole protocol treatment and 195 achieved complete remission (CR), 11 of them after a second-line treatment. Treatment abandonment rate was 22%. One hundred twenty-five patients died, of whom 49 deaths were related to treatment toxicity. A total of 275 patients are alive, including 25 despite treatment abandonment, but only 110 are known to be in CR with a follow-up. 1 year, indicating a high rate of loss to follow-up. Twelve-month overall survival (OS) was 60% (95% CI, 54% to 66%) and 63%, 60%, and 31%, respectively, for stage II bulky, III, and IV. Patients with stage III disease who started second induction course within 34 days had OS of 76%, versus 57% (P =.0062) beyond 34 days.CONCLUSION The GFA-LMB2009 protocol improved patients' survival. Early dose intensity of treatment is a strong prognostic factor. Improving supportive care and decreasing loss to follow-up are crucial. (C) 2019 by American Society of Clinical Oncology