Outcomes for paediatric Burkitt lymphoma treated with anthracycline-based therapy in Malawi

Burkitt lymphoma (BL) is the most common paediatric cancer in sub-Saharan Africa (SSA). Anthracyline-based treatment is standard in resource-rich settings, but has not been described in SSA. Children 18years of age with newly diagnosed BL were prospectively enrolled from June 2013 to May 2015 in Malawi. Staging and supportive care were standardized, as was treatment with CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) for six cycles. Among 73 children with BL, median age was 9.2years (interquartile range 7.7-11.8), 48 (66%) were male and two were positive for human immunodeficiency virus. Twelve (16%) had stage I/II disease, 36 (49%) stage III and 25 (34%) stage IV. Grade 3/4 neutropenia occurred in 17 (25%), and grade 3/4 anaemia in 29 (42%) of 69 evaluable children. Eighteen-month overall survival was 29% (95% confidence interval [CI] 18-41%) overall. Mortality was associated with age >9years [hazard ratio [HR] 2.13, 95% CI 1.15-3.94], female gender (HR 2.12, 95% CI 1.12-4.03), stage (HR 1.52 per unit, 95% CI 1.07-2.17), lactate dehydrogenase (HR 1.03 per 100iu/l, 95% CI 1.01-1.05), albumin (HR 0.96 per g/l, 95% CI 0.93-0.99) and performance status (HR 0.78 per 10-point increase, 95% CI 0.69-0.89). CHOP did not improve outcomes in paediatric BL compared to less intensive regimens in Malawi.