sidnei epelman, m.d. director – inctr brazil including mozambique in inctr’s sub-saharan african...
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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.
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Sidnei Epelman, M.D.Director – INCTR Brazil
Including Mozambique in INCTR’s sub-Saharan
African Network for the treatment of Lymphoma
Burkitt´s Belt
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Sidnei Epelman, M.D.Director – INCTR Brazil
Including Mozambique in INCTR’s sub-Saharan
African Network for the treatment of Lymphoma
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
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Sidnei Epelman, M.D.Director – INCTR Brazil
Including Mozambique in INCTR’s sub-Saharan
African Network for the treatment of Lymphoma
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
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Sidnei Epelman, M.D.Director – INCTR Brazil
Including Mozambique in INCTR’s sub-Saharan
African Network for the treatment of Lymphoma
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.
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Sidnei Epelman, M.D.Director – INCTR Brazil
Including Mozambique in INCTR’s sub-Saharan
African Network for the treatment of Lymphoma
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
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Sidnei Epelman, M.D.Director – INCTR Brazil
Including Mozambique in INCTR’s sub-Saharan
African Network for the treatment of Lymphoma
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.
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Sidnei Epelman, M.D.Director – INCTR Brazil
Including Mozambique in INCTR’s sub-Saharan
African Network for the treatment of Lymphoma
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
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Sidnei Epelman, M.D.Director – INCTR Brazil
Including Mozambique in INCTR’s sub-Saharan
African Network for the treatment of Lymphoma
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
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Sidnei Epelman, M.D.Director – INCTR Brazil
Including Mozambique in INCTR’s sub-Saharan
African Network for the treatment of Lymphoma
Cost-effective treatment
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Sidnei Epelman, M.D.Director – INCTR Brazil
Including Mozambique in INCTR’s sub-Saharan
African Network for the treatment of Lymphoma
MozambiqueParticipation
• Dr Joseph Ferro – Pathologist – Registry of Breira • Cancer Hospital in Maputo
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Sidnei Epelman, M.D.Director – INCTR Brazil
Including Mozambique in INCTR’s sub-Saharan
African Network for the treatment of Lymphoma
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)
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Sidnei Epelman, M.D.Director – INCTR Brazil
Including Mozambique in INCTR’s sub-Saharan
African Network for the treatment of Lymphoma
Retinoblastoma videoin Swahili