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Outcomes of Low-Intensity Treatment of Acute Lymphoblastic Leukemia at Butaro Cancer Center of Excellence in Rwanda.
Rubagumya, Fidel; Xu, Mary Jue; May, Leana; Driscoll, Caitlin; Uwizeye, Frank Regis; Shyirambere, Cyprien; Larrabee, Katherine; Fehr, Alexandra E; Gilbert, Umuhizi Denis; Muhayimana, Clemence; Hategekimana, Vedaste; Elmore, Shekinah; Mpunga, Tharcisse; Moore, Molly; Shulman, Lawrence N; Lehmann, Leslie.
Affiliation
  • Rubagumya F; Fidel Rubagumya, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Mary Jue Xu, University of California, San Francisco, San Francisco, CA; Leana May, Children's Hospital Colorado, Aurora, CO; Caitlin Driscoll, Mount Sinai Medical School, New York, NY; Frank Regis Uwizeye,
  • Xu MJ; Fidel Rubagumya, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Mary Jue Xu, University of California, San Francisco, San Francisco, CA; Leana May, Children's Hospital Colorado, Aurora, CO; Caitlin Driscoll, Mount Sinai Medical School, New York, NY; Frank Regis Uwizeye,
  • May L; Fidel Rubagumya, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Mary Jue Xu, University of California, San Francisco, San Francisco, CA; Leana May, Children's Hospital Colorado, Aurora, CO; Caitlin Driscoll, Mount Sinai Medical School, New York, NY; Frank Regis Uwizeye,
  • Driscoll C; Fidel Rubagumya, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Mary Jue Xu, University of California, San Francisco, San Francisco, CA; Leana May, Children's Hospital Colorado, Aurora, CO; Caitlin Driscoll, Mount Sinai Medical School, New York, NY; Frank Regis Uwizeye,
  • Uwizeye FR; Fidel Rubagumya, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Mary Jue Xu, University of California, San Francisco, San Francisco, CA; Leana May, Children's Hospital Colorado, Aurora, CO; Caitlin Driscoll, Mount Sinai Medical School, New York, NY; Frank Regis Uwizeye,
  • Shyirambere C; Fidel Rubagumya, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Mary Jue Xu, University of California, San Francisco, San Francisco, CA; Leana May, Children's Hospital Colorado, Aurora, CO; Caitlin Driscoll, Mount Sinai Medical School, New York, NY; Frank Regis Uwizeye,
  • Larrabee K; Fidel Rubagumya, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Mary Jue Xu, University of California, San Francisco, San Francisco, CA; Leana May, Children's Hospital Colorado, Aurora, CO; Caitlin Driscoll, Mount Sinai Medical School, New York, NY; Frank Regis Uwizeye,
  • Fehr AE; Fidel Rubagumya, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Mary Jue Xu, University of California, San Francisco, San Francisco, CA; Leana May, Children's Hospital Colorado, Aurora, CO; Caitlin Driscoll, Mount Sinai Medical School, New York, NY; Frank Regis Uwizeye,
  • Gilbert UD; Fidel Rubagumya, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Mary Jue Xu, University of California, San Francisco, San Francisco, CA; Leana May, Children's Hospital Colorado, Aurora, CO; Caitlin Driscoll, Mount Sinai Medical School, New York, NY; Frank Regis Uwizeye,
  • Muhayimana C; Fidel Rubagumya, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Mary Jue Xu, University of California, San Francisco, San Francisco, CA; Leana May, Children's Hospital Colorado, Aurora, CO; Caitlin Driscoll, Mount Sinai Medical School, New York, NY; Frank Regis Uwizeye,
  • Hategekimana V; Fidel Rubagumya, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Mary Jue Xu, University of California, San Francisco, San Francisco, CA; Leana May, Children's Hospital Colorado, Aurora, CO; Caitlin Driscoll, Mount Sinai Medical School, New York, NY; Frank Regis Uwizeye,
  • Elmore S; Fidel Rubagumya, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Mary Jue Xu, University of California, San Francisco, San Francisco, CA; Leana May, Children's Hospital Colorado, Aurora, CO; Caitlin Driscoll, Mount Sinai Medical School, New York, NY; Frank Regis Uwizeye,
  • Mpunga T; Fidel Rubagumya, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Mary Jue Xu, University of California, San Francisco, San Francisco, CA; Leana May, Children's Hospital Colorado, Aurora, CO; Caitlin Driscoll, Mount Sinai Medical School, New York, NY; Frank Regis Uwizeye,
  • Moore M; Fidel Rubagumya, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Mary Jue Xu, University of California, San Francisco, San Francisco, CA; Leana May, Children's Hospital Colorado, Aurora, CO; Caitlin Driscoll, Mount Sinai Medical School, New York, NY; Frank Regis Uwizeye,
  • Shulman LN; Fidel Rubagumya, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Mary Jue Xu, University of California, San Francisco, San Francisco, CA; Leana May, Children's Hospital Colorado, Aurora, CO; Caitlin Driscoll, Mount Sinai Medical School, New York, NY; Frank Regis Uwizeye,
  • Lehmann L; Fidel Rubagumya, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Mary Jue Xu, University of California, San Francisco, San Francisco, CA; Leana May, Children's Hospital Colorado, Aurora, CO; Caitlin Driscoll, Mount Sinai Medical School, New York, NY; Frank Regis Uwizeye,
J Glob Oncol ; 4: 1-11, 2018 09.
Article in En | MEDLINE | ID: mdl-30241148
ABSTRACT

PURPOSE:

Children with acute lymphoblastic leukemia (ALL) in low-income countries have disproportionately lower cure rates than those in high-income countries. At Butaro Cancer Center of Excellence (BCCOE), physicians treated patients with ALL with the first arm of the Hunger Protocol, a graduated-intensity method tailored for resource-limited settings. This article provides the first published outcomes, to our knowledge, of patients with ALL treated with this protocol.

METHODS:

This is a retrospective descriptive study of patients with ALL enrolled at BCCOE from July 1, 2012 to June 30, 2014; data were collected through December 31, 2015. Descriptive statistics were used to calculate patient demographics, disease characteristics, and outcomes; event-free survival was assessed at 2 years using the Kaplan-Meier method.

RESULTS:

Forty-two consecutive patients with ALL were included. At the end of the study period, 19% (eight) were alive without evidence of relapse three completed treatment and five were continuing treatment. Among the remaining patients, 71% (30) had died and 10% (four) were lost to follow-up. A total of 83% (25) of the deaths were disease related, 3% (one) treatment-related, and 13% (four) unclear. Event-free survival was 22% (95% CI, 11% to 36%), considering lost to follow-up as an event, and 26% (95% CI, 13% to 41%) if lost to follow-up is censored.

CONCLUSION:

As expected, relapse was the major cause of failure with this low-intensity regimen. However, toxicity was acceptably low, and BCCOE has decided to advance to intensity level 2. These results reflect the necessity of a data-driven approach and a continual improvement process to care for complex patients in resource-constrained settings.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Antineoplastic Combined Chemotherapy Protocols / Precursor Cell Lymphoblastic Leukemia-Lymphoma Type of study: Guideline Limits: Child / Female / Humans / Male Country/Region as subject: Africa Language: En Journal: J Glob Oncol Year: 2018 Document type: Article
Fulltext
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Antineoplastic Combined Chemotherapy Protocols / Precursor Cell Lymphoblastic Leukemia-Lymphoma Type of study: Guideline Limits: Child / Female / Humans / Male Country/Region as subject: Africa Language: En Journal: J Glob Oncol Year: 2018 Document type: Article