Factors influencing survival among Kenyan children diagnosed with endemic Burkitt lymphoma between 2003 and 2011: A historical cohort study.
Factors influencing survival among Kenyan children diagnosed with endemic Burkitt lymphoma between 2003 and 2011: A historical cohort study.
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DOI：
10.1002/ijc.30170
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发表时间：
2016-09-15
影响因子：
6.4
通讯作者：
Moormann AM
中科院分区：
文献类型：
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作者：
Buckle G;Maranda L;Skiles J;Ong'echa JM;Foley J;Epstein M;Vik TA;Schroeder A;Lemberger J;Rosmarin A;Remick SC;Bailey JA;Vulule J;Otieno JA;Moormann AM
在资源有限的情况下，发现如何提高存活率并为被诊断为地方性Burkitt淋巴瘤(EBL)的儿童建立临床参考点，重新引起了国际关注。使用多因素分析，我们评估了肯尼亚428名EBL儿童的年龄、性别、肿瘤分期、营养状况、血红蛋白、乳酸脱氢酶(LDH)、EB病毒(EBV)和恶性疟原虫，并在诱导化疗(环磷酰胺、长春新碱、甲氨蝶呤和阿霉素)之前确定预测和预后生存的生物标志物。在这项为期十年的前瞻性研究期间，22%的患者在住院期间死亡，78%的患者完成了6个疗程的化疗。在这些患者中，16%的患者后来复发或死亡；31%的患者实现了无事件生存；31%的患者失去了随访；总体一年生存率为45%。在调整协变量后，低血红蛋白(8g/dL)和高LDH(400mU/ml)与死亡风险增加相关(调整后的危险比分别为1.57[0.97至2.41]和1.84[0.91至3.69])。与没有贫血或疟疾感染的患者相比，患有疟疾的贫血儿童死亡的可能性高出3.55倍[1.10至11.44]。EBV载量与肿瘤分期无关，也与生存期无关。系统层面的因素也可能导致糟糕的结果。在这种情况下，与接受准确剂量的环磷酰胺(AHR=1.43[0.84至2.43])或阿霉素(AHR=1.25，[0.66至2.35])的儿童相比，意外过量超过正确剂量的环磷酰胺(AHR=1.43[0.84至2.43])或阿霉素(AHR=1.25，[0.66至2.35])的儿童更有可能死亡。这项研究编纂了与非洲EBL患者预后不良相关的风险因素，并提供了一个基准，用于评估新化疗方法的生存改善情况。
Discovering how to improve survival and establishing clinical reference points for children diagnosed with endemic Burkitt lymphoma (eBL) in resource-constrained settings has recaptured international attention. Using multivariate analyses, we evaluated 428 children with eBL in Kenya for age, gender, tumor stage, nutritional status, hemoglobin, lactate dehydrogenase (LDH), Epstein-Barr virus (EBV) and Plasmodium falciparum prior to induction of chemotherapy (cyclophosphamide, vincristine, methotrexate, and doxorubicin) to identify predictive and prognostic biomarkers of survival. During this ten year prospective study period, 22% died in-hospital and 78% completed six-courses of chemotherapy. Of those, 16% relapsed or died later; 31% achieved event-free-survival; and 31% were lost to follow-up; the overall one-year survival was 45%. After adjusting for co-variates, low hemoglobin (<8g/dL) and high LDH (>400 mU/ml) were associated with increased risk of death (adjusted Hazard Ratio (aHR)=1.57 [0.97 to 2.41]) and aHR=1.84, [0.91 to 3.69], respectively). Anemic children with malaria were 3.55 times more likely to die [1.10 to 11.44] compared to patients without anemia or malarial infection. EBV load did not differ by tumor stage nor was it associated with survival. System-level factors can also contribute to poor outcomes. Children were more likely to die when inadvertently overdosed by more than 115% of the correct dose of cyclophosphamide (aHR=1.43 [0.84 to 2.43]), or doxorubicin (aHR=1.25, [0.66 to 2.35]), compared to those receiving accurate doses of the respective agent in this setting. This study codifies risk factors associated with poor outcomes for eBL patients in Africa and provides a benchmark by which to assess improvements in survival for new chemotherapeutic approaches.