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.

Director – INCTR Brazil Including Mozambique in INCTR’s sub-Saharan African Network for the treatment of Lymphoma Burkitt´s Belt

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

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

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.

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

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.

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

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

Sidnei Epelman, M.D. Director – INCTR Brazil Including Mozambique in INCTR’s sub-Saharan African Network for the treatment of Lymphoma Cost-effective treatment

Sidnei Epelman, M.D. Director – INCTR Brazil Including Mozambique in INCTR’s sub-Saharan African Network for the treatment of Lymphoma Mozambique Participation Dr Joseph Ferro – Pathologist – Registry of Breira Cancer Hospital in Maputo

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)

Sidnei Epelman, M.D. Director – INCTR Brazil Including Mozambique in INCTR’s sub-Saharan African Network for the treatment of Lymphoma Retinoblastoma video in Swahili