Feasibility of a Dose-Intensive Regimen for Pediatric Burkitt Lymphoma in Malawi

• Published in: Blood 2023-11, Vol.142 (Supplement 1), p.4509-4509
• Main Authors: Mzikamanda, Rizine R, Mulanje, Loviisa, Matatiyo, Apatsa, Mwale, Zoe, Mapurisa, Gugulethu, Namazzi, Ruth, El-Mallawany, Nader Kim, McAtee, Casey Lee, Westmoreland, Katherine Douglas, Allen, Carl E, Ozuah, Nmazuo
• Format: Article
• Language: English
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood-2023-185302

Introduction: Burkitt lymphoma (BL) is the commonest childhood cancer diagnosed in Sub-Saharan Africa (SSA). It is highly curable with survival rates >90% in resource-rich settings with dose-intensive regimens that contain the anti-CD20 monoclonal antibody, rituximab, high-dose methotrexate (HDMTX; ≥ 3000 mg/m 2) and high-dose cytarabine. In contrast, outcomes in SSA where patients typically receive less intense chemotherapy with lower-dose methotrexate (≤1000 mg/m 2) and without rituximab, remain poor. Major drawbacks to implementing HDMTX regimens in SSA include lack of adequate supportive care and inability to monitor drug levels. Improving long-term outcomes for BL in SSA requires graduated, stepwise, and cautious escalation of treatment tailored to available supportive care infrastructure. Based on the available evidence, we adopted a resource-adapted HDMTX-containing regimen as our standard of care for pediatric BL in Lilongwe, Malawi. We report preliminary data on patients treated with this regimen. Methods: This is a prospective study of children (