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Clinical course and prognostic factors of children with Burkitt’s lymphoma in a developing country: the experience of a single centre in Brazil
Rev Bras Hematol Hemoter. 2012;34(5):361-6
with the use of MTX at a dose of 0.5 g/m
2
, because only two
patients relapsed and the other ten died of infectious or metabolic
complications before or at the beginning of treatment.
In African countries, the limited availability of drugs,
insufficient supportive measures, low social and cultural levels,
distance from the referral hospital, and political instability have
an adverse impact on patient compliance and inevitably on the
outcome of treatment
(29)
. The survival of children with B-cell
NHL living in these regions ranges from 50.5% to 79% depending
on the intensity of treatment
(3)
. Although the overall outcomes do
not compare with the experience of centers in Europe and the US
using more intensive regimens, the results remain impressive. It
is noteworthy that some of these countries provided a minimum
of therapy such as cyclophosphamide monotherapy
(26)
. This
also underscores the need to fully understand biological and
socioeconomic differences within the same disease group in an
attempt to tailor therapy and minimize toxicity. It is possible
that the poorer outcome in underdeveloped nations is not just a
reflection of socioeconomic factors, but also of unique biological
differences. It becomes increasingly clear that understanding the
molecular and genetic signatures of NHL-B can lead to novel
therapies and better survival
(30)
.
Conclusion
Our findings confirm a favorable prognosis for a significant
number of children who are survivors of BL after treatment with
an intermediate dose of MTX. The challenge remains to identify
those patients who are at a higher risk of relapsing, because they
may require more aggressive therapy. In countries with limited
resources, the challenge is to plan treatment intensity so that
morbidity is manageable, without significantly decreasing the
survival rate. The observation of a significantly lower survival in
children and adolescents with uric acid concentrations of 7 mg/dL
or higher at diagnosis is also very interesting, suggesting that the
concentration of the metabolite may be a good marker of tumor
burden, but further studies are needed to corroborate this finding.
Acknowledgements
The authors wish to thank FAPEMIG for a grant to ACSCG,
a medical student. MBV is a level 2 CNPq researcher.
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