{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T14:01:19Z","timestamp":1790172079992,"version":"4.1.0"},"reference-count":28,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T00:00:00Z","timestamp":1767571200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T00:00:00Z","timestamp":1767571200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Blood &amp;amp; Cancer"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Despite the excellent outcomes achieved for pediatric mature B\u2010cell non\u2010Hodgkin lymphoma (MB\u2010NHL) in high\u2010income countries, outcomes remain very poor in low\u2010 and middle\u2010income countries. High\u2010dose methotrexate (HD\u2010MTX), which is highly efficacious for the disease, is still not commonly used in low\u2010resource settings due to the potential for treatment\u2010associated toxicity. Though there have been more recent reports of successful use of HD\u2010MTX in resource\u2010limited settings, there are no reports to date regarding the methodology used to safely introduce HD\u2010MTX in these environments. Subsequently, at our treatment center in northern Tanzania, we endeavored to utilize implementation science methodology to elucidate generalizable methods to allow for a safe introduction of HD\u2010MTX in a resource\u2010limited setting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Procedure<\/jats:title>\n                    <jats:p>The Active Implementation Frameworks were utilized as a starting point to generate an initial implementation plan. Intervention fit was assessed, and resource mapping and cost analysis were completed. Key stakeholders were identified and engaged. Novel educational strategies, decision support tools, and protocol fidelity monitoring systems were developed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Following completion of all planning and education activities, use of a new HD\u2010MTX containing MB\u2010NHL protocol began in October of 2024. As of June 2025, 27 cycles of HD\u2010MTX have been given to a cumulative total of 10 patients. Few protocol deviations have occurred, and only one Grade III non\u2010hematologic adverse event has been reported.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The use of implementation science methodology allowed a careful introduction of the use of HD\u2010MTX for the treatment of pediatric MB\u2010NHL in a resource\u2010limited setting.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/1545-5017.70019","type":"journal-article","created":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T05:38:57Z","timestamp":1767677937000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Implementation Science Methodology for the Successful Introduction of High\u2010Dose Methotrexate for the Treatment of Pediatric Mature B\u2010Cell Non\u2010Hodgkin Lymphoma in a Resource\u2010Limited Setting"],"prefix":"10.1002","volume":"73","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5574-8532","authenticated-orcid":false,"given":"Hutton","family":"Chapman","sequence":"first","affiliation":[{"name":"Duke University Hospital  Durham North Carolina USA"},{"name":"Duke Global Health Institute  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul S.","family":"Ntemi","sequence":"additional","affiliation":[{"name":"Bugando Medical Centre  Mwanza Tanzania"},{"name":"Catholic University of Allied and Health Sciences  Mwanza Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Mahene","sequence":"additional","affiliation":[{"name":"Bugando Medical Centre  Mwanza Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dativa","family":"Zelama","sequence":"additional","affiliation":[{"name":"Bugando Medical Centre  Mwanza Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacqueline","family":"Kamanga","sequence":"additional","affiliation":[{"name":"Bugando Medical Centre  Mwanza Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1002-0596","authenticated-orcid":false,"given":"Goodluck","family":"Nchasi","sequence":"additional","affiliation":[{"name":"Bugando Medical Centre  Mwanza Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heronima","family":"Kashaigili","sequence":"additional","affiliation":[{"name":"Bugando Medical Centre  Mwanza Tanzania"},{"name":"Catholic University of Allied and Health Sciences  Mwanza Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6433-6174","authenticated-orcid":false,"given":"Kristin","family":"Schroeder","sequence":"additional","affiliation":[{"name":"Duke University Hospital  Durham North Carolina USA"},{"name":"Duke Global Health Institute  Durham North Carolina 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