背景:尽管在高收入国家(HIC)治疗小儿伯基特淋巴瘤(BL)取得了良好的效果,低收入和中等收入国家(LMICs)的结果仍然很差。坦桑尼亚改善BL结果的努力包括在2016年制定了《国民待遇指南》。然而,迄今为止,坦桑尼亚在制定这些指南后的疾病结局尚未报告.
方法:2016年至2021年在Bugando医学中心(BMC)看到的0-18岁诊断为BL的患者的历史记录,在姆万扎,坦桑尼亚,被编入电子数据库并进行描述性分析。该队列中的患者根据坦桑尼亚国家治疗指南接受治疗,其中包括六个环磷酰胺周期,长春新碱,甲氨蝶呤(COM)鞘内注射甲氨蝶呤和阿糖胞苷化疗。
结果:总计,92例BL患者记录符合分析条件。该队列中的患者最常见的是MurphyII期(28%)或III期(34%)。几乎所有,91%,在演示时符合国际癌症治疗和研究网络(INCTR)高风险标准。42%的患者未接受活检,仅接受了BL的假定诊断。观察到1年无事件生存率为29.6%(95%置信区间[CI]:20.3%-39.5%),1年总生存率为38.5%(95%CI:28%-48.9%)。还观察到高的治疗放弃率(34%)。
结论:在根据2016年坦桑尼亚国家治疗指南治疗的BL儿科患者的历史队列中,我们观察到不良结局和高放弃率.这些结果似乎不如在INCTR临床试验中获得的结果,该临床试验告知了指南的创建,并强调了“现实世界”结果数据在低收入国家中的重要性。这些数据强化了这样一种观点,即持续的临床研究和能力建设努力对于改善LMIC的BL结果是必要的。
BACKGROUND: Despite the excellent outcomes achieved in the treatment of pediatric Burkitt
lymphoma (BL) in high-income countries (HICs), outcomes remain poor in low- and middle-income countries (LMICs). Efforts to improve BL outcomes in Tanzania included the creation of National Treatment
Guidelines in 2016. However, disease outcomes in Tanzania following the creation of these
guidelines have not been reported to date.
METHODS: Historical records from 2016 to 2021 for patients 0-18 years of age with a diagnosis of BL and seen at Bugando Medical Centre (BMC), in Mwanza, Tanzania, were curated into an electronic database and analyzed descriptively. Patients in this cohort were treated per the Tanzanian National Treatment
Guidelines, which include six cycles of cyclophosphamide, vincristine, and methotrexate (COM) chemotherapy with intrathecal methotrexate and cytarabine.
RESULTS: In total, 92 BL patients\' records were eligible for analysis. Patients in this cohort were most commonly Murphy stage II (28%) or stage III (34%). Nearly all, 91%, met International Network for Cancer Treatment and Research (INCTR) high-risk criteria at presentation. Forty-two percent of patients did not receive a biopsy and were treated with a presumed diagnosis of BL alone. A 1-year event-free survival of 29.6% (95% confidence interval [CI]: 20.3%-39.5%) and a 1-year overall survival of 38.5% (95% CI: 28%-48.9%) were observed. A high rate of treatment abandonment (34%) was also observed.
CONCLUSIONS: In a historical cohort of pediatric patients with BL treated per the 2016 Tanzanian National Treatment Guidelines, we observed poor outcomes and a high rate of abandonment. These outcomes appear inferior to those achieved in the INCTR clinical trial that informed the
guidelines\' creation, and highlights the importance of \"real-world\" outcomes data in LMICs. These data reinforce the idea that continued clinical research and capacity building efforts are necessary to improve BL outcomes in LMICs.