St John of God Hospital, Mabesseneh, Sierra Leone.
Trans R Soc Trop Med Hyg. 2013 Oct;107(10):653-9. doi: 10.1093/trstmh/trt069. Epub 2013 Sep 10.
Sierra Leone is a low-income sub-Saharan country in the endemic Burkitt's lymphoma (BL) belt. We performed a prospective trial of a reduced-intensity chemotherapy protocol for the treatment of paediatric BL.
The trial included all children clinically diagnosed with BL between 2005 and 2008. Biopsy, bone-marrow aspiration, analysis of cerebrospinal fluid, abdominal ultrasound and plain x-ray of involved sites were performed when feasible. The treatment protocol was a first i.v. dose of cyclophosphamide (CPM) 40 mg/kg, followed by oral CPM weekly for two doses and then bimonthly to a total of six doses. Treatment was based on clinical diagnosis as it was several weeks before pathology results were available.
Eighty-seven patients were included, with a median age 7 years and 4 months; 59/87 (67.8%) were boys. Nearly half (n = 17, 42.5%), presented with moderate or severe malnutrition. Biopsy was performed in 44 patients, BL being verified in 36 (41.4% of all patients). Most children presented with advanced disease: 28 (32%) at stage II, 47 (54%) at stage III and 12 (13.8%) at stage IV. Most patients (71/87, 82%) initially responded to treatment, but just over half (47/87, 54%) experienced relapse and refractory disease. Forty patients (46%) in complete or partial clinical response were lost to follow-up.
The outcome for BL in rural Sierra Leone according to this protocol is poor. Low-dose CPM was ineffective. Constraints on performing complete diagnosis and staging, frequency of advanced disease at presentation and a high drop-out rate might explain our poor results.
塞拉利昂是一个位于撒哈拉以南非洲地区的低收入国家，是布基特淋巴瘤（BL）的流行区。我们进行了一项前瞻性研究，评估了一种低强度化疗方案治疗儿科 BL 的效果。
该试验纳入了 2005 年至 2008 年间所有经临床诊断为 BL 的儿童。可行时进行活检、骨髓抽吸、脑脊液分析、腹部超声和受累部位的平片检查。治疗方案为静脉注射首剂环磷酰胺（CPM）40mg/kg，随后每周口服 CPM 两次，共 6 个剂量，每 2 个月一次。治疗基于临床诊断，因为在获得病理结果之前需要数周时间。
共纳入 87 例患者，中位年龄为 7 岁 4 个月；59/87（67.8%）为男性。近一半（n=17，42.5%）患者存在中重度营养不良。44 例患者进行了活检，36 例（所有患者的 41.4%）证实为 BL。大多数患儿处于晚期疾病：28 例（32%）为 II 期，47 例（54%）为 III 期，12 例（13.8%）为 IV 期。大多数患者（71/87，82%）初始治疗有效，但仅有一半（47/87，54%）发生复发和难治性疾病。40 例（46%）完全或部分临床缓解的患者失访。
根据该方案，塞拉利昂农村地区 BL 的治疗效果不佳。低剂量 CPM 无效。完全诊断和分期的限制、就诊时晚期疾病的高发率以及较高的失访率可能解释了我们的不良结果。
