MIME-Version: 1.0 Content-Type: multipart/related; boundary="----=_NextPart_01C66867.02498290" This document is a Single File Web Page, also known as a Web Archive file. If you are seeing this message, your browser or editor doesn't support Web Archive files. Please download a browser that supports Web Archive, such as Microsoft Internet Explorer. ------=_NextPart_01C66867.02498290 Content-Location: file:///C:/CF154A01/AfricanBurkitt'sLymphoma,StrategyGroupReport-TwalibNgoma.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" African Burkitt’s Lymphoma Strategy Group Report

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 ------=_NextPart_01C66867.02498290 Content-Location: file:///C:/CF154A01/AfricanBurkitt'sLymphoma,StrategyGroupReport-TwalibNgoma_files/master04.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii"
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‹date/time›
INCTR
2004
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------=_NextPart_01C66867.02498290 Content-Location: file:///C:/CF154A01/AfricanBurkitt'sLymphoma,StrategyGroupReport-TwalibNgoma_files/pres.xml Content-Transfer-Encoding: quoted-printable Content-Type: text/xml; charset="utf-8" ------=_NextPart_01C66867.02498290 Content-Location: file:///C:/CF154A01/AfricanBurkitt'sLymphoma,StrategyGroupReport-TwalibNgoma_files/slide0001.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" African Burkitt’s Lymphoma Strategy Group Report
=
INCTR
2004
African Burkitt’s Lymphoma Strategy Group Report
Presented by Twalib Ngoma for
M.A. Durosinmi
Obafemi Awolowo University Teaching = Hospitals Complex, Ile-Ife, Nigeria<= /div>
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file:///C:/CF154A01/AfricanBurkitt'sLymphoma,StrategyGroupReport-TwalibNgoma_files/slide0003.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" African Burkitt’s Lymphoma Strategy Group Report
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INCTR
2004
The Journey So Far
Meetings Held to Date
&s= ect;1st=  June 2002
–Discuss on-going activities in the treatment of African BL in sub-Saharan Africa
= 211;Determine interest in the development of a collaborative program for= the study of this disease
= 211;Determine interest in the development of a common treatment protocol= for African BL
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The Journey So Far
Meetings Held to Date
§6 = - 7th=  Dec = 2002
–D= evelop a strategy for characterization and treatment
–S= tandardize COM regimen
–S= tandardize IT therapy
–D= evelop gene expression studies
–D= iscuss ethical considerations
–P= lan data management
–P= lan strategies to improve patient follow-up
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The Journey So Far
Meetings Held to Date
&s= ect;31st=  May 2003
–Review progress with standardized COM regimen
&= #8211;Finalize treatment protocol for African BL
&= #8211;Discuss gene expression studies
&= #8211;Discuss serum EBV DNA studies
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The Journey So Far
Meetings Held to Date
&s= ect;Protocol Implementation Meeting
&= #8211;12 – 13th August 2004 Da= r es Salaam, Tanzania
&= #8211;Review of the protocol document
–In-depth review of the case report forms & data management procedures =
&= #8211;Decide protocol “activation” date
&= #8211;Discuss data quality assurance plan
&= #8211;Discuss potential new studies
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Background Experience with Standa= rd COM at Ile-Ife
Patient Characteristics=
35
Total Patients
2 - 13
Range (weeks)
4
Median (weeks)
Duration of Symptoms
4 - 22
Range
6
Median
Age
22/13
Sex (Males/Females)
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Background Experience
Stage and Risk Group
34
High Risk
1
Low Risk
=
Risk Group
15
D
15
C
3
B
2
A
=
Stage (Ziegler)
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Background Experience
Sites of Disease
1
Spleen
1
Bone marrow
1
Intracerebral tumor
1
Hemiplegia
3
Blindness
9
Cranial nerve palsies   
10
CNS
7
Abdomen and jaw
18
Jaw
21
Abdomen
Total No
Site
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Background Experience
Response
3
Not treated
1
NR
2
PD
2
PR     
27
CR
No of patients
Response
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Problems Encountered During Pilot of COM
§12/32 treated patients completed planned treatment (others unable to pay for therapy)= 3;
§1 patient = died of neutropenic sepsis
§Reversible myelosuppression noted in many patients
§
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Problems Encountered During Pilot of COM
§4 deaths (2, PD, 1, e= arly relapse and 1, sepsis)
<= span class=3DBB style=3D'position:absolute;left:-4.51%'>§28/32 trea= ted patients lost to follow-up
§All drugs for second-line treatment were not available during the pilot phase
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Comments – Pilot of COM
§CR rate superior with standardized COM =
§Drug toxicity is minimal
–Anticipated mucositis = did not occur
–No tumor lysis with hydration regimen
§Price is affordable (USD 160 for 6 cycles) = and drugs are available
§To avoid default, it will be necessary to <= span style=3D'position:absolute;top:79.25%;left:12.17%;width:79.4%;height:6.75%= '>provide drugs for treatment
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Protocol INCTR 03-06
§Title: “The Tre= atment and Characterization of Burkitt’s Lymphoma in Africa”
<= span class=3DBB style=3D'position:absolute;left:-4.32%'>§5 particip= ating institutions in 4 countries
§Anticipated rate of accrual – 180 – 240 eligible patients/year
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Participating Institutions in Africa
&s= ect;KENYA
–Kenyatta National Hospital, University of Nairobi, Nairobi (Dr Jessie Githang’a)
&s= ect;NIGERIA
= 211;University College Hospital, Ibadan (Dr Yetunde Aken’ova) <= /div>
–Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife (Dr MA Durosinmi)
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2004
Participating Institutions in Africa
&s= ect;TANZANIA
–Ocean Road Cancer Institute, Dar es Salaam (Dr Twalib Ngoma)
&s= ect;UGANDA
= 211;Mbarara University of Science and Technology, Mbarara (Dr Julius Kiwanu= ka)
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INCTR Personnel
&s= ect;Medical Advisors
&= #8211;Ian Magrath
&= #8211;Ama Rohatiner
&= #8211;Aziza Shad
&s= ect;Study Coordination and Data Management
&= #8211;Melissa Adde
&= #8211;Lolita Lantican
§
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Protocol Design
&s= ect;Eligibility Criteria
–Diagnosis – BL, Burkitt-like and Large B cell lymphoma
&= #8211;Patients aged > 2 - < 60 years
&= #8211;No history of prior treatment
§
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Protocol Design
&s= ect;First-Line Treatment
&= #8211;Low Risk Arm
&= #8226;Single extra-abdominal mass < 10 cm
&= #8211;High Risk Arm
&#= 8226;All other patients not meeting low risk definition
&s= ect;Second-Line Treatment
&= #8211;Failures of First-Line Treatment
•
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First-Line Treatment
§
§Low Risk Arm
–3 cycles of treatment&= #13;
–Administered every 14 days
§High Risk Arm
–6 cycles of treatment&= #13;
–CNS disease IT therapy= x 6 cycles
–No CNS disease –= IT therapy x 3 cycles
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First-Line Treatment
4
IT ARAC
1 and 8
IT MTX
1
MTX 75 mg/m2 IV
1
VCR 1.4 mg/m2 IVP
1
CTX 1200 mg/m2 IV
Day
Drug
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Second-Line Treatment
&s= ect;Criteria for Second-Line Treatment
&= #8211;Failures of First-Line Treatment
&= #8226;NR/PD
&= #8226;No CR after 2 cycles
&= #8226;Early relapse (within 3 months)
&s= ect;Total 4 cycles
&s= ect;Administered every 21 days
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Second-Line Treatment
4
IT ARAC
1 and 8
IT MTX
1-3
ARAC 100 mg/m2 IV
1-3
MESNA 300 mg/m2 IV x 4
1-3
IFOS 1500 mg/m2 IV
1-3
ETOP 60 mg/m2 IV
Day(s)
Drug
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Other Elements to be Added
§Molecular profiling of African BL versus BL in Europe
–Comparison with clinic= al characteristics
–Comparison with treatm= ent outcome
§EBV DNA in serum
–Comparison with clinic= al stage
–Evaluation as a progno= stic indicator (relapse)
§Tumor and serum samples to be collected pending development of funding
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Activation of Protocol INCTR 03-06
§Data managers in 4/5 participating centers
–Assist with patient monitoring & follow up
–Data collection
§Patient accrual began 15th Aug 2004
§Total patients accrued to date:  6
§Total patients not entered to date: 8 (6, not eligible due to prior treatment; 1, refused; 1, died before diagnosis confirmed)
§
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Summary
§Ethical approval
–<= /span>INCTR ERC and 4/5 participating institutions <= /span>
§Protocol Implementation Meeting,&nbs= p; Aug, 2004
§Infrastructure for data management, including patient follow-up in place in most participating <= /span>institutions
§Patient accrual has begun
§Support for costs of treatment are being pursued
§
&se= ct;
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Appreciation
<= span class=3DBB style=3D'position:absolute;left:-3.99%'>§Members of= the African BL Strategy Group
§Colleagues= in Department of Haemotology and Paediatrics, OAUTHC, Ile-Ife
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THANK YOU FOR YOUR = ATTENTION
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