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

Background. Twenty-five percent of South African children aged 6-71 months are undernourished and have stunted growth. The tolerance and efficacy of s hort, high-dose intense chemotherapy for B-cell lymphomas in such a populat ion were unknown. Procedure. Nineteen consecutive children diagnosed with B -cell lymphoma after 1993 at Tygerberg Hospital (TBH) in the Republic of So uth Africa (RSA) were treated according to the LMB-89 protocol. Results. Am ong 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 sta ge II), 14 in group B (nonresected stage I, nonabdominal stage II, all stag e III, stage IV with bone marrow involvement but <70% Burkitt cells and wit hout CNS involvement) and 2 in group C (patients with >70% Burkitt cells in bone marrow and/or CNS involvement). Overall survival for these children w as 79% (median follow-up 53.5 months,range 20-70 months) compared to 25% (m edian follow-up 131 months, range 71-173 months) for 24 children who bad be en 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 feb rile neutropenia and 1.9 episodes of stomatitis per patient and required in tensive support, but there were no toxic deaths. Conclusions. A major step forward was achieved for South African children with B-cell lymphoma. Despi te 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 can not measure methotrexate (MTX) serum levels should not exceed 3.0 g/m(2) o f MTX. If supportive care facilities are limited, consideration should be g iven to reducing the doses of cyclophosphamide and of doxorubicin in the tr eatment schedules. Med. Pediatr. Oncol. 34:143-146, 2000. (C) 2000 Wiley-Li ss, Inc.