This review article, published online in the British Journal of Haematology, addressed some of the underlying causes of poor survival of children with mature B-cell lymphoma (ie, Burkittlymphoma) from lower- and middle-income countries (LMIC), and summarized potentially feasible interventions for improving the cure rates of these children.
The incidence of Burkitt lymphoma in children varies greatly depending on geographic region. Although the “best” treatment strategy for children with Burkitt lymphoma has not been identified, cure rates of approximately 90% have been achieved in higher-income countries (HIC) through administration of high-dose, intensive chemotherapy regimens, consisting of widely available, relatively inexpensive agents, tailored according to patient risk. However, cure rates of only 20% to 70% are achieved in this patient population in LMIC. Reasons include lack of diagnosis,misdiagnosis, advanced disease, treatment abandonment (related to many factors including lack of logistical support for families of patients living far from the treatment center), and toxic death from comorbidities, such as malnutrition and infections.
Some of the interventions suggested to improve survival of children with Burkitt lymphoma in LMIC include the following:
- Implementation of early supportive care measures, including intensive nutritional support,management of infections and aggressive hydration to prevent tumor-lysis syndrome,as well as administration of granulocyte-stimulating growth factors and rasburicase (when possible)
- Use of serum lactate dehydrogenase to tailor therapy when more complex tests cannot be performed
- Use of lower-dose regimens when a more complex, high-dose protocol cannot beimplemented
- Omission of methotrexate from the initial block or shortened methotrexate infusionduration to reduce toxic death, with the possible addition of rituximab (when possible)
- Introduction of tracking protocols for families of patients who miss appointments
- Subsidized transportation and housing for patients and their families
- Development of national, evidence-based guidelines for the treatment of non-Hodgkin lymphoma in children
- Regularly scheduled online meetings for discussion of patient cases with remote specialists
- Chantada G, Lam CG, Howard SC. Optimizing outcomes for children with non-Hodgkinlymphoma in low- and middle-income countries by early correct diagnosis,reducing toxic death and preventing abandonment [published online February 10,2019]. Br J Haematol. doi: 10.1111/bjh.15785