High-dose intense chemotherapy in South African children with B-cell lymphoma: Morbidity, supportive measures, and outcome

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dc.contributor.authorWessels G.
dc.contributor.authorHesseling P.B.
dc.date.accessioned2011-05-15T16:17:21Z
dc.date.available2011-05-15T16:17:21Z
dc.date.issued2000
dc.description.abstractBackground. Twenty-five percent of South African children aged 6-71 months are undernourished and have stunted growth. The tolerance and efficacy of short, high-dose intense chemotherapy for B-cell lymphomas in such a population were unknown. Procedure. Nineteen consecutive children diagnosed with B-cell lymphoma after 1993 at Tygerberg Hospital (TBH) in the Republic of South Africa (RSA) were treated according to the LMB-89 protocol. Results. Among the 19 children treated according to the LMB-89 protocol, there were 3 children in group A (completely resected St. Jude stage I and abdominal stage II), 14 in group B (nonresected stage I, nonabdominal stage II, all stage III, stage IV with bone marrow involvement but <70% Burkitt cells and without CNS involvement) and 2 in group C (patients with >70% Burkitt cells in bone marrow and/or CNS involvement). Overall survival for these children was 79% (median follow-up 53.5 months, range 20-70 months) compared to 25% (median follow-up 131 months, range 71-173 months) for 24 children who had been treated with COM±P prior to 1993 (P = 0.002). Toxicity was noteworthy in the children treated with LMB-89. They had a mean of 2.6 episodes of febrile neutropenia and 1.9 episodes of stomatitis per patient and required intensive support, but there were no toxic deaths. Conclusions. A major step forward was achieved for South African children with B-cell lymphoma. Despite a high prevalence of malnutrition and endemic infections in the RSA, the implementation of the LMB-89 protocol significantly improved survival with manageable morbidity. Our findings suggest that treatment centres that cannot measure methotrexate (MTX) serum levels should not exceed 3.0 g/m2 of MTX. If supportive care facilities are limited, consideration should be given to reducing the doses of cyclophosphamide and of doxorubicin in the treatment schedules. (C) 2000 Wiley-Liss, Inc.
dc.description.versionArticle
dc.identifier.citationMedical and Pediatric Oncology
dc.identifier.citation34
dc.identifier.citation2
dc.identifier.issn00981532
dc.identifier.other10.1002/(SICI)1096-911X(200002)34:2<143::AID-MPO15>3.0.CO;2-1
dc.identifier.urihttp://hdl.handle.net/10019.1/14177
dc.subjectcyclophosphamide
dc.subjectcytarabine
dc.subjectdoxorubicin
dc.subjecthydrocortisone
dc.subjectprednisone
dc.subjectvincristine
dc.subjectantineoplastic activity
dc.subjectarticle
dc.subjectB cell lymphoma
dc.subjectcancer combination chemotherapy
dc.subjectcancer survival
dc.subjectchild
dc.subjectclinical article
dc.subjectfemale
dc.subjectfever
dc.subjecthuman
dc.subjectmale
dc.subjectneutropenia
dc.subjectpriority journal
dc.subjectstomatitis
dc.subjecttreatment outcome
dc.subjectAntineoplastic Agents
dc.subjectChild
dc.subjectChild, Preschool
dc.subjectFemale
dc.subjectHumans
dc.subjectInfant
dc.subjectLymphoma, B-Cell
dc.subjectMale
dc.subjectSouth Africa
dc.subjectTreatment Outcome
dc.titleHigh-dose intense chemotherapy in South African children with B-cell lymphoma: Morbidity, supportive measures, and outcome
dc.typeArticle
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