Participants
We implemented the Chichewa Pediatric PROMIS-25 measure to assess HRQoL of patients aged 5-18 years with lymphoma who were diagnosed at KCH between June 2016 and September 2018. All patients were enrolled in the KCH Lymphoma study, an observational prospective cohort study that began in 2013, and were followed for two years after treatment completion.2,22,23
Patients were staged using physical examination, chest radiography, abdominal ultrasound, unilateral bone marrow biopsy, and cerebrospinal fluid cytology, as previously described.2,22 The clinician-reported Lansky performance score (LPS), routinely used in cancer clinical trials for children <16 years, was obtained at diagnosis.24 All lymphoma diagnoses were pathologically confirmed using tissue biopsies and immunohistochemistry and were interpreted during real-time weekly telepathology conferences.21
Standard chemotherapy regimens were administered and evolved during the study period, and as previously described: Hodgkin lymphoma patients received ABVE-PC regimen (doxorubicin, bleomycin, vincristine, etoposide – prednisone & cyclophosphamide); low-risk Burkitt Lymphoma patients received COMP (cyclophosphamide, vincristine, methotrexate and prednisone); and high-risk Burkitt lymphoma initially received CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) and more recently received modified COPADM (cyclophosphamide, vincristine, prednisone, doxorubicin, methotrexate).2,22,23Radiotherapy is not available in Malawi.