Resource‐adapted strategies in the management of paediatric Burkitt lymphoma in low‐ and middle‐income country setting and outcomes: An Indian centre experience

Summary Burkitt lymphoma (BL) is a challenging cancer to treat in resource‐limited settings. We retrospectively analysed 85 BL children ≤14 years, treated during 2007–2017. Median age was 6.5 (2–12) years. Group A, B and C disease was seen in 22%, 48% and 30% respectively. Advanced disease was seen in 78% (stage III 33, stage IV 25). Six children had stage I and 21 had stage II disease. The commonest primary site was the abdomen (56%). Ten children had central nervous system (CNS) and 22 had marrow involvement. Treatment protocols included cyclophosphamide, oncovin, methotrexate, prednisolone (COMP) (United Kingdom Childhood Cancer Study Group) for group A and Multi Centre Protocol 842 (MCP 842) (2007–2008)/modified Lymphomes Malins de Burkitt (LMB) 96 (2009–2017) for group B and C disease. Seventeen children developed tumour lysis syndrome (TLS). Twenty‐two children (25%) expired, six from TLS, four from infection and 12 due to disease. Median follow‐up was 8.6 (4–15) years. Four‐year event‐free survival (EFS) and overall survival (OS) were 72.9% and 74.1% respectively. Four‐year OS for group A, B, C and stage I, II, III, IV was 100%, 73.2%, 56% ( p = 0.005) and 100%, 90.5%, 72.7%, 56% ( p = 0.02) respectively. Advanced disease and TLS were significant predictors of inferior EFS on multivariate analysis. We could achieve reasonably good survival in resource‐limited settings with judicious use of resources like single‐dose rasburicase and modified dose methotrexate.