How I treat Burkitt lymphoma in children, adolescents, and young adults in sub-Saharan Africa

Blood. 2018 Jul 19;132(3):254-263. doi: 10.1182/blood-2018-04-844472. Epub 2018 May 16.


Burkitt lymphoma (BL) is the most common pediatric cancer in sub-Saharan Africa (SSA), and also occurs frequently among adolescents and young adults (AYAs), often associated with HIV. Treating BL in SSA poses particular challenges. Although highly effective, high-intensity cytotoxic treatments used in resource-rich settings are usually not feasible, and lower-intensity continuous infusion approaches are impractical. In this article, based on evidence from the region, we review management strategies for SSA focused on diagnosis and use of prephase and definitive treatment. Additionally, potentially better approaches for risk stratification and individualized therapy are elaborated. Compared with historical very low-intensity approaches, the relative safety, feasibility, and outcomes of regimens incorporating anthracyclines and/or high-dose systemic methotrexate for this population are discussed, along with requirements to administer such regimens safely. Finally, research priorities for BL in SSA are outlined including novel therapies, to reduce the unacceptable gap in outcomes for patients in SSA vs high-income countries (HICs). Sustained commitment to incremental advances and innovation, as in cooperative pediatric oncology groups in HICs, is required to transform care and outcomes for BL in SSA through international collaboration.

Publication types

  • Case Reports
  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Adolescent
  • Adult
  • Africa South of the Sahara / epidemiology
  • Biomarkers
  • Burkitt Lymphoma / diagnosis
  • Burkitt Lymphoma / epidemiology*
  • Burkitt Lymphoma / therapy
  • Child
  • Combined Modality Therapy
  • Comorbidity
  • Disease Management
  • Drug Resistance, Neoplasm
  • Female
  • Humans
  • Male
  • Positron Emission Tomography Computed Tomography / methods
  • Recurrence
  • Risk Assessment
  • Severity of Illness Index
  • Tomography, X-Ray Computed / methods
  • Treatment Outcome
  • Young Adult


  • Biomarkers