Sidnei Epelman, M.D. Director – INCTR Brazil Including Mozambique in INCTR’s sub-Saharan African...

Sidnei Epelman, M.D.Director – INCTR Brazil

Including Mozambique in INCTR’s sub-Saharan

African Network for the treatment of Lymphoma

Including Mozambique in INCTR’s Sub-Saharan African Network for the treatment of Lymphoma

Sidnei Epelman, M.D.




Burkitt´s Belt




BL Study

• 5 participants centers in 4 sub-Saharan African countries– Kenya– Nigeria– Tanzania– Uganda

• Purpose– Characterize presentation features of BL– Assess response and treatment outcome




Study objectives

• Primary– Characterize presentation features of Burkitt’s

Lymphoma in African countries– Assess response, EFS, DFS and OS – Characterize pattern of CNS disease and

relapse – Assess toxicities to the regimen

• Secondary– Pattern of gene expression in African BL– Assess levels of sEBV DNA and correlate with

clinican features and response to therapy




First-Line Treatment

• Treatment Groups• Low Risk Group• Patients with a single extra-abdominal tumor of

less than 10 cm in size, in its widest diameter.• High Risk Group• All patients who do not meet the definition of low

risk.




First-Line Treatment Low Risk Group

• Day 1 Vincristine 1.4 mg/m2 h IV• Day 1 Cyclophosphamide 1200 mg/m2 IV• Day 1 Methotrexate 75 mg/m2 IV • Day 1 Methotrexate intrathecal (IT) • Day 4 Cytarabine IT• Day 8 Methotrexate IT• Total of 3 cycles of therapy.• Every 14 days




First-Line Treatment High Risk Group

• Day 1 Vincristine 1.4 mg/m2, • Day 1 Cyclophosphamide 1200 mg/m2 IV• Day 1 Methotrexate 75 mg/m2, IV• Day 1 Methotrexate intrathecal • Day 4 Cytarabine IT• Day 8 Methotrexate IT • Total of 6 cycles of therapy • Every 14 days

CNS TREATMENT • High risk patients without CNS disease – as above

during the first 3 cycles of therapy.• High risk patient with CNS disease - as described

above during all 6 cycles of therapy.




Second-line Treatment

• Days 1-3 Etoposide 60 mg/m2 IV• Days 1-3 Ifosfamide 1500 mg/m2 IV • Days 1-3 Mesna 300 mg/m2 IV mixed with

ifosfamide and then 300 mg/m2 mesna Injection for 3 additional doses at hours 3, 6 and 9 post ifosfamide..

• Days 1-3 Cytarabine 100 mg/m2 IV• Day 1 Methotrexate IT• Day 4 Cytarabine IT• Day 8 Methotrexate IT• Total of 6 cycles of therapy• Every 14 days




Supported from INCTR

• Drugs• Data management

– Data base– Registration– Monitoring for errors– Assistance with analysis of data

• Consultation in specific cases when needed• Training and Education in Santa Marcelina - SP




Cost-effective treatment




MozambiqueParticipation

• Dr Joseph Ferro – Pathologist – Registry of Breira • Cancer Hospital in Maputo




On going Programms in Lusophone Africa

• Development of the program for early diagnosis in Retinoblastoma - all materials (video, posters, cards, etc) are already in Portuguese and Swahili.

• Implementation of Palliative Care Program - PAX program - (education and training can be provided at Santa Marcelina Hospital )

• Development of Protocol for Burkitt´s lymphoma (results will presented by Melissa Adde)

• Training and Education in Pediatric Oncology at Santa Marcelina Hospital in Sao Paulo - fellow from Angola

• Raising funds (e.g, concert in London)




Retinoblastoma videoin Swahili

Sidnei Epelman, M.D. Director – INCTR Brazil Including Mozambique in INCTR’s sub-Saharan African...

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