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

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.