{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,26]],"date-time":"2025-10-26T13:57:36Z","timestamp":1761487056613},"reference-count":13,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2003,10,24]],"date-time":"2003-10-24T00:00:00Z","timestamp":1066953600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Med. Pediatr. Oncol."],"published-print":{"date-parts":[[2003,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Burkitt lymphoma (BL) accounts for 50% of childhood cancer in Malawi. Lack of resources precludes the use of new successful treatment approaches such as the LMB 89 group B protocol, which cures &gt;80% of children with stage III BL with high dose chemotherapy and matching supportive care. Our objective was to achieve a good cure rate in Murphy stage I\u2013III BL with manageable toxicity in Malawi at a drug cost of &lt;1,000 US dollars per patient.<\/jats:p><\/jats:sec><jats:sec><jats:title>Procedure<\/jats:title><jats:p>The intensity and toxicity of the LMB 89 group B protocol was reduced and adapted to Malawi realities. All stages received the same treatment. Children with suspected BL in the period July 1997\u2013November 1999 were subjected to abdominal ultrasound, a tumor biopsy and\/or fine needle aspirate (FNA) and bone marrow (BM), cerebrospinal fluid (CSF), and peripheral blood examination. HIV seropositive children were excluded. Endpoints are projected event free survival (EFS) at minimum 1 year, blood and gastro\u2010intestinal tract toxicity, and risk for and severity of infections.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Forty\u2010four children were eligible for treatment and analysis. Their median age was 7.2 years, M:F ratio 1.4:1 with 10 stage I, 5 stage II, and 29 stage III patients. Projected Kaplan\u2013Meier EFS for all was 57% (CI 41\u201373) at 1 year with 90% EFS in stage I and 52% EFS in stage III. The survival curve remained stable at 500 days. Toxicity and delays in appropriate supportive care contributed to ten deaths during treatment. Local recurrent tumor caused five and CNS recurrence one death. Two children died from progressive disease. The incidence of severe (grade 3 and\/or 4) hematologic toxicity varied from 13% to 36%, gastro\u2010intestinal toxicity (GIT) from 2% to 17%, and infections from 7% to 41% per chemotherapy module.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>It is possible to administer less intense and less costly multiagent chemotherapy to children with BL in a developing society with acceptable EFS rates. Adequate supportive care of the at\u2010times associated severe toxicity must be made available to better the results. Med Pediatr Oncol 2003;41:532\u2013540. \u00a9 2003 Wiley\u2010Liss, Inc.<\/jats:p><\/jats:sec>","DOI":"10.1002\/mpo.10322","type":"journal-article","created":{"date-parts":[[2003,10,29]],"date-time":"2003-10-29T11:00:29Z","timestamp":1067425229000},"page":"532-540","source":"Crossref","is-referenced-by-count":64,"title":["Malawi pilot study of Burkitt lymphoma treatment"],"prefix":"10.1002","volume":"41","author":[{"given":"Peter B.","family":"Hesseling","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robin","family":"Broadhead","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth","family":"Molyneux","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric","family":"Borgstein","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johann W.","family":"Schneider","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mercia","family":"Louw","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erna P.G.","family":"Mansvelt","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Glynn","family":"Wessels","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2003,10,24]]},"reference":[{"key":"e_1_2_1_2_2","unstructured":"1995 University of Stellenbosch Printers Stellenbosch South Africa L Banda PB Hesseling G Wessels Pattern of the most common malignancies in MalawiProceedings of the First Continental Meeting of the International Society of Paediatric Oncology in Africa 12 13"},{"key":"e_1_2_1_3_2","doi-asserted-by":"publisher","DOI":"10.3109\/08880019509029569"},{"key":"e_1_2_1_4_2","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.2910260302"},{"key":"e_1_2_1_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0950-3536(05)80206-9"},{"key":"e_1_2_1_6_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V97.11.3370"},{"key":"e_1_2_1_7_2","first-page":"350","article-title":"Outcome of B\u2010cell lymphomas treated at Tygerberg Hospital, Republic of South Africa","volume":"29","author":"Wessels G","year":"1997","journal-title":"Med Pediatr Oncol"},{"key":"e_1_2_1_8_2","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1096-911X(200002)34:2<143::AID-MPO15>3.0.CO;2-1"},{"key":"e_1_2_1_9_2","unstructured":"UNICEF.The state of the world's children 1999. 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