{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,18]],"date-time":"2026-07-18T07:42:52Z","timestamp":1784360572567,"version":"3.55.0"},"reference-count":23,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2020,8,31]],"date-time":"2020-08-31T00:00:00Z","timestamp":1598832000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Blood &amp; Cancer"],"published-print":{"date-parts":[[2020,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Even though rituximab has emerged as standard of care for the management of high\u2010risk pediatric Burkitt lymphoma (BL), its safety in children from the low\u2013middle\u2010income countries (LMICs) remains to be proven. We herein report our experience of using rituximab in children with BL.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>All patients diagnosed with BL between January 2015 and December 2017 were treated in a risk\u2010stratified manner with either the modified MCP\u2010842 or modified LMB protocol. Patients with poor response to MCP\u2010842 were switched to the LMB\u2010salvage regimen. In addition, rituximab was given to selected high\u2010risk patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Result<\/jats:title><jats:p>Forty\u2010two (49.4%) of 85 patients with BL received rituximab. The incidence of febrile neutropenia (90.5%\u00a0vs 67.4%; <jats:italic>P<\/jats:italic>\u00a0=\u00a00.02), pneumonia (38.1%\u00a0vs 11.6%; <jats:italic>P<\/jats:italic>\u00a0=\u00a00.005), intensive care unit admissions (54.5%\u00a0vs 17.6%; <jats:italic>P<\/jats:italic>\u00a0=\u00a00.002), and toxic deaths (26.2%\u00a0vs 9.3%; <jats:italic>P<\/jats:italic>\u00a0=\u00a00.04) was higher among BL patients who received rituximab. Pneumonia was fatal in 11 of 16 (69%) patients who received rituximab. On multivariate analysis, rituximab continued to be significantly associated with toxic deaths ( OR: 11.45 [95% CI: 1.87\u201070.07; <jats:italic>P<\/jats:italic>\u00a0=\u00a00.008]). The addition of rituximab to intensive chemotherapy resulted in an inferior one\u2010year event\u2010free survival (49.4% \u00b1 8.1%\u00a0vs 79.3% \u00b1 6.5%; <jats:italic>P<\/jats:italic>\u00a0=\u00a00.025) and one\u2010year overall survival (63.1% \u00b1 8.5%\u00a0vs 91.8% \u00b1 4.5%; <jats:italic>P<\/jats:italic>\u00a0=\u00a00.007) with no improvement in one\u2010year relapse\u2010free survival (78.3% \u00b1 7.3% vs 83.9% \u00b1 6.0%; <jats:italic>P<\/jats:italic>\u00a0=\u00a00.817).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Rituximab was associated with increased toxicities and toxic deaths in our patients. The potential immunomodulatory effect of rituximab and increased susceptibility to infections in patients from LMICs have to be carefully considered while choosing this drug in the treatment of BL in resource\u2010constrained settings.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pbc.28682","type":"journal-article","created":{"date-parts":[[2020,8,31]],"date-time":"2020-08-31T15:41:04Z","timestamp":1598888464000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Increased toxicities in children with Burkitt lymphoma treated with rituximab: Experience from a tertiary cancer center in India"],"prefix":"10.1002","volume":"67","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2587-9181","authenticated-orcid":false,"given":"Shyam","family":"Srinivasan","sequence":"first","affiliation":[{"name":"Department of Pediatric Oncology Tata Memorial Hospital Homi Bhabha National Institute  Mumbai Maharashtra 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