Sunday, January 8, 2012


Burkitt Lymphoma. A mature B cell neoplasm. Characterized by rapid
grown and most commonly maxillo-facial envolvement - it is the most
common pediatric cancer in Africa. Caused by the Epstein Barr Virus
and augmented in malarial-endemic zones of sub-saharan Africa, untreated
Burkitt Lymphoma is aggressive and devastating.

According to a study by the French-African Pediatric Oncology Group
(GFAOP) published in 2011, median age of diagnosis is 7 years old with a
male to female ratio of 2:1.

The article focuses on improvement of patient outcomes using
Cyclophosamide Monotheraphy. In a nut-shell - Cyclophosamide is a
cyto-toxic chemotherapy agent most commonly used to treat Burkitt
Lymphoma. Used in conjunction with methotrexate, prednisone,
dexamethasone etc to prevent tumor necrosis syndrome and subsequent
renal failure it has resulted in complete remission in roughly 50% of
cases studied.

blah blah blah

I have seen 2 cases of Burkitt Lymphoma since I have been working in
Pediatrics here. The one I will never forget is Clison.

Male. check.

7 years old. check.

Sub-Saharan Africa. check.

geographically malarial-endemic zone. check.

He originally came before I got here. He had a massive tumor on his jaw
on the left side of his face. Through the gracious efforts of American
Donors, the doctor initiated the cyclophosamide therepy.

And by a tumor I mean it engulfed his face. Difficult to talk,
difficult to eat, to smell, to see.

here, due to a variety of contributing factors, this is how we do
cyclophosamide. We initiate it with 1 gram of cyclophosamide in a
bolus. Then we follow that with 5 days of mandatory hospitalization and
dexamethasone 4 grams every 6 hours. The interesting and often exciting
thing about treating this tumor is that when the therapy is effective we
will see a noticeable decrease in the tumor. it is possible to see
measurable diminishment on a day to day basis.

I don't know how many weeks of theraphy he received, but i think it was
5 or 6. and then he went home. the tumor looked like it was gone.

several weeks later, he was back.

the tumor swallowing up the left side of his face again. he was here
for 7 more weeks. malnutrion, anemia, malaria. stick thin arms and
legs. and then his body started reacting to the dexa. he developed
absesses all over his body. his old IV site was a tunneling pussy wound
that streaked all the way up his arm.

he developed a super-infection. he developed an absess in the tumor.
the tumor receded somewhat, but not drastically. not nearly enough.

he went home for several weeks. because every day he cried because he
wanted to see his brother. i didn't think he would come back.

but he did.

and the tumor was even worse. this time affecting both sides of his
face. unable to open his left eye. difficult to speak, almost
impossible to chew.

another round of cyclophosamide. to do or not to do. what do we want
to get him in the end.....the tumor....or the infection.

they decided to do it. one more week.

the tumor remained the same.

see the picture. thats him. thats Clison. that is a person. that is
a person I should never have gotten close to. that is a person i
couldn't help getting close to.

i don't even technically like children

a child that perfectly fits the description of Burkitt Lymphoma. A
child that went home today and is not coming back.

I played disney movies for him every day. brought him bananas and
candy. and he would sit up so straight and so still. and shake my hand
very gravely. and then he told his parents he wanted to go home to live
with me.

he started equating me with candy. but I didn't care.

and we had a rather serious discussion in which he insisted I leave the
hospital that very minute and walk the 20 minutes to my hut to get him
juice, explaining in Gumbi why that was an absolute necessity.

and he loves to color.

and loves to draw.

little orange mud huts

and loves juice.

and loves his brothers.

and he is going home today. and soon he won't be able to eat anymore.
or talk anymore. and the wrist that is the size of my thumb is going to
get even skinnier. and then his right eye is going to close. and it is
going to be slow. and it is going to hurt. and he is only seven.

he never got to go to disney world. or college.

he never got to get married or grow old.

we did absolutely everything we could for him. every medicine in the
book. every medicine out of the book.

and there isn't anything we should have done differently.

and there isn't any point to this story.

other than sometimes life is horribly, horribly unfair.

and this isn't very well written, and sounds rather plastic, but thats
all i got.

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