Cure 250 Children with Burkitt Lymphoma in Africa

Raphael and his family come from a village in the district of Kole in northern Uganda – a journey with accessible roads and available transportation - that can take up to two and a half hours or more to reach our hospital, St. Mary’s Hospital Lacor in Gulu, Uganda.

Rapahel was referred to us by a health center nearby his home. His father accompanied him to our hospital. He provided us with Raphael’s social and recent medical history as the health center did not provide a referral letter. His father stated that he left six other children and his wife at home in order to bring 11 year old Raphael to St. Mary's. Both parents work as subsistence farmers – meaning that the family has very few financial resources. He informed us that Raphael had suffered with progressive swelling in the right jaw for three months. The swelling was initially thought to be due to an infected tooth. Raphael was otherwise well and had no other symptoms except for mild pain when we examined his very enlarged right jaw.

Based upon our findings at the time of his admission, we suspected that Raphael had Burkitt lymphoma. We did a full work-up that included blood tests, an ultrasound of his abdomen, and a biopsy of his jaw mass. The biopsy findings confirmed that he had Burkitt lymphoma. He had no other evidence of disease. We started him on the INCTR protocol for this cancer. He responded well to initial chemotherapy and his face is no longer disfigured by the jaw mass.   

Due to the costs of transportation, which have substantially increased during the global pandemic, it was considered best for Raphael and his father to remain at the hospital’s family home during treatment. So far, Raphael has completed five of six planned cycles of chemotherapy. While with us, he continues with his primary school studies at the Rainbow Family Home School. His only major complaint has been about the food – evidently, he prefers home-style cooking!

We thank everyone who supports this project so that poor children who live in rural areas like Raphael can receive free treatment, have a chance for cure, and receive the social support that they need, including the opportunity to continue their education at the Rainbow Family Home School especially during prolonged stays away from home. Thank you again for your generous donations! 

Kalum, aged ten, was brought to St. Mary’s Hospital Lacor in Gulu, Uganda by her father in late September of 2020. They travelled 200 kilometers from their village in the Moyo District to come to our hospital. Her mother remained at home to continue her work as a peasant farmer and to care for Kalum’s seven siblings.

Approximately six weeks prior to admission, Kalum’s father reported that she had a tooth extraction and soon afterwards developed rapidly progressive and painful swelling of her left jaw. Upon examination, we noted that the left side of her face was grossly deformed and that she had a mass protruding from the inside of her mouth. Her abdomen was mildly distended and a mass in the right upper abdominal quadrant was palpable and very tender. She had no other clinical signs of disease.

We performed routine laboratory work as well as other diagnostic tests, including an abdominal ultrasound. The ultrasound showed that she had multiple solid masses in her liver as well as a mass in her right kidney. Her other tests were negative. A biopsy of her jaw mass was taken. The results of the biopsy confirmed that she had Burkitt lymphoma.

Based upon the results of the investigations, it was decided to treat Kalum according to the high-risk arm of the INCTR treatment protocol for Burkitt lymphoma – meaning that she would receive a total of six cycles of chemotherapy with intrathecal therapy to prevent spread of disease to her central nervous system. She was started on treatment as soon as possible.  

After two cycles of chemotherapy, she had an excellent response. There was complete resolution of all masses in her abdomen as well as her jaw mass. She recently finished her sixth and last cycle of treatment and tests performed at this time showed that she was in complete remission.

Because treatment cycles for Burkitt lymphoma are given every two weeks and any unnecessary delays in treatment for this particularly aggressive cancer – such a discharge to a home far away from the hospital - can have negative consequences, it was decided that Kalum needed to remain with us for the duration of her treatment. Once she finished all planned therapy, she was very excited to go back home to see her siblings after her long hospital stay!  

Your donations to this project support the costs of treatment and gives children with Burkitt lymphoma the opportunity and hope for long-term cure. Your donations also help to support the costs of transportation so that children and their parents can reach a hospital capable of treating this very curable cancer. Transportation costs are all too often unaffordable for families like Kalum’s. Thank you again for generosity!

Ronald’s grandfather brought him to St Mary’s Hospital Lacor in Gulu, Uganda after Ronald experienced a one-month history of progressive painful swelling of his right jaw. They arrived at St Mary’s in June amidst the Covid-19 pandemic after a long journey from their home in the north western part of the country.

When ten-year old Ronald was admitted to the hospital, he was a very ill. His face was very deformed due to gross swelling of the jaw and he had a visible mass protruding through his mouth. Ronald had difficulty with speech and eating. He also had loosening of his teeth. He underwent other tests which did not show spread of disease to other parts of his body. His clinical features were classical for Burkitt lymphoma and a biopsy taken of the jaw mass confirmed our suspected diagnosis.

He was then started on first-line chemotherapy according to the INCTR treatment protocol for Burkitt lymphoma. After the first cycle, Ronald’s grandfather made the decision to take Ronald home – which is a very long distance from St Mary’s Hospital – for financial reasons. The family’s income is derived from subsistence farming. Ronald’s biological father does not provide financial support for Ronald and his eight siblings. Therefore, Ronald’s grandfather and mother must work to feed and care for the family.

Ronald missed his appointment for the next cycle of therapy. After contacting his grandfather, we learned that he had no money to bring Ronald back to St Mary’s. Their home district was under lockdown due to Covid-19 and no public transportation was available. The hiring of a driver with a private vehicle was an option. However, this option was both cost-prohibitive and illegal. With the help of a local NGO, St Mary’s was able to transport Ronald back to the hospital to continue treatment.

Even though he had a five-week delay after the first cycle of therapy, Ronald did not have any signs of progression of disease when he returned. He completed the second cycle of therapy and is just beginning the third cycle. He is doing well and has had a complete resolution of his jaw tumor. In an aggressive cancer such as Burkitt lymphoma, it is important that all planned treatment is completed and without unnecessary delays so that a child with this cancer has the best chance for cure. Ronald is now staying at the hospital’s Family Home to ensure that he completes treatment and avoids delays due to lack of transportation caused by restrictions imposed during the Covid-19 pandemic.

Thanks to your generous donations to this project, poor children from rural villages have access to the necessary treatment for Burkitt lymphoma. Your support provides families and children with the hope of long-lasting cure. Thank you again for your support.

Allan, a 14-year old boy, came to St Mary’s Hospital Lacor in January.  He was accompanied by his mother. They reported that he had a three-month history of progressive and painful abdominal swelling. He stated that he had also lost weight, particularly in the month prior to admission to St Mary's. On examination, we found him to be very ill and severely malnourished. In addition to the visible abdominal distention, we could easily feel a well-defined mass in his upper right abdomen.  

Allan immediately underwent a series of tests that showed that he had disease that was widespread throughout his abdomen. He had multiple masses in his liver and a very large mass within his abdominal cavity. A biopsy taken of the abdominal mass confirmed our suspected diagnosis of Burkitt lymphoma. He promptly began the appropriate treatment for this type of cancer which consists of six cycles of chemotherapy. In addition to chemotherapy, he received nutritional rehabilitation. The first cycle of chemotherapy was a tough one for Allan. Because of the extent of his disease, Allan had to be carefully supported prior to the initiation of the first cycle and monitored closely once treatment began to ensure that his kidneys were working well – especially when his lymphoma began to break down - which can sometimes result in kidney failure and death. After he made it through these first few days, he developed dangerously low levels of infection-fighting white blood cells that also had the potential to be life-threatening. He recovered from the first cycle and went on to complete the rest of his chemotherapy with minimal side effects. All signs of his Burkitt lymphoma disappeared after the first two cycles of therapy.

Before Allan became ill, he lived with his parents and four siblings in the Lira District in northern Uganda. He performed very well in school.  He helped his mother in the family’s garden to ensure that they had sufficient food to eat. He also helped his mother when she needed to go to the market to buy other food and supplies for the family. During treatment, he was always concerned about his mother because she was the sole provider for the family as sadly, his father was mentally unwell. The hospital staff thought that he was very mature for his age.   

Now that he has completed treatment, Allan cannot wait to resume his normal life.  He wants to continue to support his mother in whatever ways he can. He also wishes to return to school and complete his education so that one day, he can become a teacher - his big dream for the future.

Thank you to everyone who supports this project. Without your donations, children like Allan would not be able to receive an accurate diagnosis and the appropriate care and treatment for this highly curable cancer. Children with Burkitt lymphoma need to be given the chance for cure – no matter how extensive their tumor may be at the time of diagnosis – so that they, too, can be given hope to fulfill their dreams for the future.

Ruth was 9 years old when she first came to St Mary’s Hospital Lacor in Gulu. She is from a village in Lira, the district that borders Gulu in northern Uganda.   Her father brought her to St Mary’s in June 2019 after she experienced a one-month history of progressive and painful abdominal swelling.  

When she was admitted to our hospital, Ruth was quite ill. Her nutritional status was very poor and she had severe wasting. Upon examination, she had a grossly distended abdomen and an ill-defined mass that was palpable and very large.  She underwent blood work, a chest x-ray and an ultrasound of her abdomen.  The ultrasound revealed that she had multiple tumors in her liver, a separate large mass within her abdominal cavity as well as fluid in the abdomen.  A biopsy of the large abdominal mass was performed which confirmed that she had Burkitt lymphoma.

Ruth required supportive care, including nutritional support, and was started on first-line (FL) chemotherapy for Burkitt lymphoma that consisted of cyclophosphamide, vincristine, methotrexate and treatment to prevent the spread of disease to her central nervous system.

Unfortunately, Ruth did not respond to FL treatment as we had hoped. Therefore, after two cycles of FL therapy, she was immediately changed to the second-line treatment which is intended for patients such as Ruth who do not respond well to FL therapy. The drugs used in this second-line regimen are different to FL. She responded very well to this salvage regimen. Although it is more intensive - meaning that patients can experience more prolonged or serious side effects than with FL therapy, Ruth tolerated second-line therapy well. She completed all planned treatment and achieved a complete response. Ruth was recently seen at the hospital and has no evidence of disease. And, she is recovering her strength.

Thanks to your generous donations to this project, poor children from rural villages have access to the necessary treatment for Burkitt lymphoma, including salvage therapy when needed, in order to provide them with the hope for long-lasting cure and the chance to fulfill their dreams. Thank you again for your support.