Presentation of African Burkitt Lymphoma Study in Lugano
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In the 1st Quarter edition (2015) of the NewsFlash, the results being achieved at St Mary's Hospital in the district of Gulu (Uganda) in

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the treatment of Burkitt lymphoma were described. It was also mentioned that the the scientific committee of one of the must prestigious meetings on lymphoid neoplasia, held in Lugano every 3 years, had selected the project for oral presentation. Since then, Dr Valeria Calbi, who coordinates the study at St Mary's Hospital, Lachor has given the presentation, which was extremely well received. The remarkably high survival rate of 71% at 3 years is a result of INCTR's long standing interest in the disease, (which is the most frequently observed lymphoma in Ugandan children and accounts for half of all pediatric cancers), and its efforts to demonstrate what can be achieved in Africa with due attention to the basic principals of oncology. An extensive analysis of the detailed information that has been collected in patients treated with the treatment protocol described by Dr Calbi has been performed. This work was made possible with the help and support of Nick and Emma Seaford (see picture), who, as mentioned in another article in this edition of the NewsFlash, after visiting Brussels for their own training, assisted the team at St Mary's Hospital, Lachor, in the conduct of the study and the collection of accurate information regarding response and toxicity using a purpose-built data base designed by Ms Melissa Adde, Head of the INCTR Clinical Trials Office and presently also Executive Director of INCTR, and Jovan Vladic, a highly skilled and knowledgeable informatics expert with whom INCTR has worked for many years. Their work has confirmed that extensive abdominal disease with additional extraabdominal sites, excluding solely facial tumor, is an indicator of a high risk for recurrent disease. New approaches to improving the results even more will now be considered. I essence, the so-called "first line" (initial) treatment, which is given to all patients will be alternated with the second line regimen which is normally used only if patients do not achieve complete remission or relapse shortly after achieving complete remission (a state in which no tumor can be detected). The first line therapy is known as "COM" (cyclophosphamide, vincristine and methotrexate) Although the INCTR African Lymphoma Group has shown that the second line therapy, a cytosince arabinoside and the mesna/Ifosfamide combination are active in Burkitt lymphoma patients, even in a proportion of those who have not achieved a complete response, or who have relapsed very soon after completion of COM, not all of them have returned for treatment with the salvage regimen. This approach (alternating the two regimens) has been successful in Burkitt lymphoma in both Egypt and India, and it is, therefore, likely to succeed in Africa. It ensures that all patients receive both of the active regimens incorporated into the protocol. Only 4 cycles of this alternating regimen will be given unless there is evidence of incompletely eradicated disease, when up to two additional cycles will be given. An alternative approach would be to give the alternating regimen only to high risk patients - namely those with both abdominal disease and disease elsewhere. This will now be discussed and a new protocol written. In addition, the staff of surrounding hospitals will be trained to recognize Burkitt lymphoma and rapidly refer patients to St Mary's Hospital for urgent treatment. These two measures - treatment at the earliest possible time after diagnosis and assurance that all high risk patients at least, will receive both regimens is likely to result in even more patients with this disease being cured. This should provide encouragement to other countries with similarly limited resources to treat at least selected patients with cancer with potentially curative therapy. See also the article on membership Expanding the INCTR Membership.

This work was generously supported by a grant from OFID (the OPEC Fund for International Development).

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