{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,12]],"date-time":"2026-11-12T13:42:22Z","timestamp":1794490942312,"version":"4.9.1"},"reference-count":28,"publisher":"American Society of Hematology","issue":"4","content-domain":{"domain":["ashpublications.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2019,2,26]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Burkitt lymphoma (BL) is common in sub-Saharan Africa (SSA). In high-income countries, BL is highly curable with chemotherapy. However, there are few prospective studies from SSA describing nonpediatric BL and no regional standard of care. Thirty-five participants age 15 years or older with newly diagnosed BL were enrolled in Malawi from 2013 to 2018. Chemotherapy was administered according to institutional guidelines, with concurrent antiretroviral therapy if HIV infected. Median age was 21 years (range, 15-61) and 15 participants (43%) were HIV infected. Twenty-seven participants (77%) had stage III to IV disease, and 19 (54%) had Eastern Cooperative Oncology Group performance status &amp;gt;1. Among HIV-infected participants, median CD4 count was 130 (range, 29-605) and 10 (67%) had suppressed HIV viral load. Four participants (11%) died before receiving chemotherapy. First-line chemotherapy consisted of: cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) (n = 22 [71%]); infusional etoposide, prednisolone, vincristine, cyclophosphamide, and doxorubicin (n = 4 [13%]); high-dose methotrexate-based chemotherapy (n = 4 [13%]); and rituximab plus CHOP (n = 1 [3%]). Among 28 evaluable participants, 14 (50%) achieved a complete response. Median overall survival (OS) was 7 months; 1-year OS was 40% (95% confidence interval [CI], 24%-56%). Sixteen (73%) of 22 deaths were a result of disease progression. Compared with CHOP, more intensive chemotherapy was associated with decreased mortality (hazard ratio, 0.24; 95% CI, 0.05-1.02; P = .05). This is among the best characterized prospective cohorts of nonpediatric BL in SSA. Most deaths resulted from progressive BL. Patients who received more intensive therapy seemed to have better outcomes. Defining optimal approaches is an urgent priority in SSA.<\/jats:p>","DOI":"10.1182\/bloodadvances.2018029199","type":"journal-article","created":{"date-parts":[[2019,2,22]],"date-time":"2019-02-22T16:45:21Z","timestamp":1550853921000},"page":"612-620","update-policy":"https:\/\/doi.org\/10.1182\/blood.2019cm0000","source":"Crossref","is-referenced-by-count":26,"title":["Prospective study of Burkitt lymphoma treatment in adolescents and adults in Malawi"],"prefix":"10.1182","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9175-7436","authenticated-orcid":false,"given":"Matthew S.","family":"Painschab","sequence":"first","affiliation":[{"name":"University of North Carolina Project\u2013Malawi, Lilongwe, Malawi;"},{"name":"Lineberger Comprehensive Cancer Center, Chapel Hill, NC;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6509-7382","authenticated-orcid":false,"given":"Kate D.","family":"Westmoreland","sequence":"additional","affiliation":[{"name":"University of North Carolina Project\u2013Malawi, Lilongwe, Malawi;"},{"name":"Lineberger Comprehensive Cancer Center, Chapel Hill, NC;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1543-814X","authenticated-orcid":false,"given":"Edwards","family":"Kasonkanji","sequence":"additional","affiliation":[{"name":"University of North Carolina Project\u2013Malawi, Lilongwe, Malawi;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3780-0207","authenticated-orcid":false,"given":"Takondwa","family":"Zuze","sequence":"additional","affiliation":[{"name":"University of North Carolina Project\u2013Malawi, Lilongwe, Malawi;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9501-7125","authenticated-orcid":false,"given":"Bongani","family":"Kaimila","sequence":"additional","affiliation":[{"name":"University of North Carolina Project\u2013Malawi, Lilongwe, Malawi;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8789-2413","authenticated-orcid":false,"given":"Peter","family":"Waswa","sequence":"additional","affiliation":[{"name":"Texas Children\u2019s Hospital, Houston, TX;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6115-1046","authenticated-orcid":false,"given":"Nader Kim","family":"El-Mallawany","sequence":"additional","affiliation":[{"name":"Texas Children\u2019s Hospital, Houston, TX;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5183-8714","authenticated-orcid":false,"given":"Tamiwe","family":"Tomoka","sequence":"additional","affiliation":[{"name":"University of North Carolina Project\u2013Malawi, Lilongwe, Malawi;"},{"name":"University of Malawi College of Medicine, Blantyre, Malawi;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8623-2205","authenticated-orcid":false,"given":"Maurice","family":"Mulenga","sequence":"additional","affiliation":[{"name":"Kamuzu Central Hospital, Lilongwe, Malawi; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6136-3057","authenticated-orcid":false,"given":"Nathan D.","family":"Montgomery","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2135-2908","authenticated-orcid":false,"given":"Yuri","family":"Fedoriw","sequence":"additional","affiliation":[{"name":"Lineberger Comprehensive Cancer Center, Chapel Hill, NC;"},{"name":"Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2314-0316","authenticated-orcid":false,"given":"Satish","family":"Gopal","sequence":"additional","affiliation":[{"name":"University of North Carolina Project\u2013Malawi, Lilongwe, Malawi;"},{"name":"Lineberger Comprehensive Cancer Center, Chapel Hill, NC;"},{"name":"University of Malawi College of Medicine, Blantyre, Malawi;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"234","published-online":{"date-parts":[[2019,2,22]]},"reference":[{"issue":"5","key":"2020021108323831500_B1","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1002\/pbc.20917","article-title":"Spectrum and presentation of pediatric malignancies in the HIV era: experience from Blantyre, Malawi, 1998-2003","volume":"48","author":"Sinfield","year":"2007","journal-title":"Pediatr Blood Cancer"},{"issue":"6","key":"2020021108323831500_B2","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1016\/S1470-2045(17)30186-9","article-title":"International incidence of childhood cancer, 2001-10: a population-based registry study","volume":"18","author":"Steliarova-Foucher","year":"2017","journal-title":"Lancet Oncol"},{"issue":"4","key":"2020021108323831500_B3","first-page":"1","article-title":"Frequent HIV and young age among individuals with diverse cancers at a national teaching hospital in Malawi","author":"Horner","year":"2018","journal-title":"J Glob Oncol"},{"issue":"12","key":"2020021108323831500_B4","doi-asserted-by":"crossref","first-page":"1645","DOI":"10.1097\/01.aids.0000238411.75324.59","article-title":"Trends in cancer risk among people with AIDS in the United States 1980-2002","volume":"20","author":"Engels","year":"2006","journal-title":"AIDS"},{"issue":"11","key":"2020021108323831500_B5","doi-asserted-by":"crossref","first-page":"3370","DOI":"10.1182\/blood.V97.11.3370","article-title":"The Soci\u00e9t\u00e9 Fran\u00e7aise d\u2019Oncologie P\u00e9diatrique LMB89 protocol: highly effective multiagent chemotherapy tailored to the tumor burden and initial response in 561 unselected children with B-cell lymphomas and L3 leukemia","volume":"97","author":"Patte","year":"2001","journal-title":"Blood"},{"issue":"6","key":"2020021108323831500_B6","doi-asserted-by":"crossref","first-page":"1138","DOI":"10.1002\/pbc.21452","article-title":"Treatment of B-cell lymphoma with LMB modified protocols in Africa--report of the French-African Pediatric Oncology Group (GFAOP)","volume":"50","author":"Harif","year":"2008","journal-title":"Pediatr Blood Cancer"},{"issue":"3","key":"2020021108323831500_B7","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1182\/blood-2018-04-844472","article-title":"How I treat Burkitt lymphoma in children, adolescents, and young adults in sub-Saharan Africa","volume":"132","author":"Gopal","year":"2018","journal-title":"Blood"},{"issue":"3","key":"2020021108323831500_B8","doi-asserted-by":"crossref","first-page":"925","DOI":"10.1200\/JCO.1996.14.3.925","article-title":"Adults and children with small non-cleaved-cell lymphoma have a similar excellent outcome when treated with the same chemotherapy regimen","volume":"14","author":"Magrath","year":"1996","journal-title":"J Clin Oncol"},{"issue":"7","key":"2020021108323831500_B9","doi-asserted-by":"crossref","first-page":"1569","DOI":"10.1002\/cncr.21776","article-title":"Chemoimmunotherapy with hyper-CVAD plus rituximab for the treatment of adult Burkitt and Burkitt-type lymphoma or acute lymphoblastic leukemia","volume":"106","author":"Thomas","year":"2006","journal-title":"Cancer"},{"issue":"10036","key":"2020021108323831500_B10","doi-asserted-by":"crossref","first-page":"2402","DOI":"10.1016\/S0140-6736(15)01317-3","article-title":"Rituximab and dose-dense chemotherapy for adults with Burkitt\u2019s lymphoma: a randomised, controlled, open-label, phase 3 trial","volume":"387","author":"Ribrag","year":"2016","journal-title":"Lancet"},{"issue":"20","key":"2020021108323831500_B11","doi-asserted-by":"crossref","first-page":"1915","DOI":"10.1056\/NEJMoa1308392","article-title":"Low-intensity therapy in adults with Burkitt\u2019s lymphoma","volume":"369","author":"Dunleavy","year":"2013","journal-title":"N Engl J Med"},{"issue":"1","key":"2020021108323831500_B12","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1002\/cncr.23522","article-title":"High-dose chemotherapy and immunotherapy in adult Burkitt lymphoma: comparison of results in human immunodeficiency virus-infected and noninfected patients","volume":"113","author":"Oriol","year":"2008","journal-title":"Cancer"},{"issue":"8","key":"2020021108323831500_B13","doi-asserted-by":"crossref","first-page":"2846","DOI":"10.1182\/blood-2006-10-051771","article-title":"Intensive chemotherapy regimen (LMB86) for St Jude stage IV AIDS-related Burkitt lymphoma\/leukemia: a prospective study","volume":"110","author":"Galicier","year":"2007","journal-title":"Blood"},{"issue":"3","key":"2020021108323831500_B14","doi-asserted-by":"crossref","first-page":"e0150445","DOI":"10.1371\/journal.pone.0150445","article-title":"CHOP chemotherapy for aggressive non-Hodgkin lymphoma with and without HIV in the antiretroviral therapy era in Malawi","volume":"11","author":"Gopal","year":"2016","journal-title":"PLoS One"},{"issue":"4","key":"2020021108323831500_B15","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1093\/ajcp\/aqw118","article-title":"Accurate real-time diagnosis of lymphoproliferative disorders in Malawi through clinicopathologic teleconferences: a model for pathology services in sub-Saharan Africa","volume":"146","author":"Montgomery","year":"2016","journal-title":"Am J Clin Pathol"},{"issue":"1","key":"2020021108323831500_B16","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1016\/j.cll.2017.10.011","article-title":"Practical successes in telepathology experiences in Africa","volume":"38","author":"Montgomery","year":"2018","journal-title":"Clin Lab Med"},{"issue":"5","key":"2020021108323831500_B17","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1111\/bjh.13986","article-title":"Outcomes for paediatric Burkitt lymphoma treated with anthracycline-based therapy in Malawi","volume":"173","author":"Stanley","year":"2016","journal-title":"Br J Haematol"},{"issue":"7","key":"2020021108323831500_B18","doi-asserted-by":"crossref","first-page":"2773","DOI":"10.1182\/blood-2006-07-036673","article-title":"Results of the randomized international FAB\/LMB96 trial for intermediate risk B-cell non-Hodgkin lymphoma in children and adolescents: it is possible to reduce treatment for the early responding patients","volume":"109","author":"Patte","year":"2007","journal-title":"Blood"},{"issue":"1","key":"2020021108323831500_B19","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1186\/s13027-017-0156-3","article-title":"Salvage chemotherapy for adults with relapsed or refractory lymphoma in Malawi","volume":"12","author":"Kaimila","year":"2017","journal-title":"Infect Agent Cancer"},{"key":"2020021108323831500_B20","unstructured":"U.S. National Library of Medicine,\n          ClinicalTrials.gov: Rituximab plus CHOP chemotherapy for diffuse large B-cell lymphoma. Identifier NCT02660710. Available at:https:\/\/clinicaltrials.gov\/ct2\/show\/NCT02660710. Accessed 13 November 2018."},{"issue":"197","key":"2020021108323831500_B21","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1002\/bjs.18004619704","article-title":"A sarcoma involving the jaws in African children","volume":"46","author":"Burkitt","year":"1958","journal-title":"Br J Surg"},{"issue":"25","key":"2020021108323831500_B22","doi-asserted-by":"crossref","first-page":"5600","DOI":"10.1182\/blood-2010-03-275917","article-title":"AIDS-related Burkitt lymphoma in the United States: what do age and CD4 lymphocyte patterns tell us about etiology and\/or biology?","volume":"116","author":"Guech-Ongey","year":"2010","journal-title":"Blood"},{"issue":"24","key":"2020021108323831500_B23","doi-asserted-by":"crossref","first-page":"4861","DOI":"10.1182\/blood-2012-12-475558","article-title":"Trends in survival of patients with Burkitt lymphoma\/leukemia in the USA: an analysis of 3691 cases","volume":"121","author":"Costa","year":"2013","journal-title":"Blood"},{"issue":"3","key":"2020021108323831500_B24","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1200\/JGO.2015.002378","article-title":"Burkitt\u2019s lymphoma and B-cell lymphoma unclassifiable with features intermediate between diffuse large B-cell lymphoma and Burkitt\u2019s lymphoma in patients with HIV: outcomes in a South African public hospital","volume":"3","author":"Sissolak","year":"2016","journal-title":"J Glob Oncol"},{"issue":"9822","key":"2020021108323831500_B25","doi-asserted-by":"crossref","first-page":"1234","DOI":"10.1016\/S0140-6736(11)61177-X","article-title":"Burkitt\u2019s lymphoma","volume":"379","author":"Molyneux","year":"2012","journal-title":"Lancet"},{"issue":"11","key":"2020021108323831500_B26","doi-asserted-by":"crossref","first-page":"2509","DOI":"10.1002\/ijc.30682","article-title":"Plasma Epstein-Barr virus DNA for pediatric Burkitt lymphoma diagnosis, prognosis and response assessment in Malawi","volume":"140","author":"Westmoreland","year":"2017","journal-title":"Int J Cancer"},{"issue":"5","key":"2020021108323831500_B27","doi-asserted-by":"crossref","DOI":"10.1002\/pbc.26302","article-title":"Hodgkin lymphoma, HIV, and Epstein-Barr virus in Malawi: Longitudinal results from the Kamuzu Central Hospital Lymphoma study","volume":"64","author":"Westmoreland","year":"2017","journal-title":"Pediatr Blood Cancer"},{"issue":"6","key":"2020021108323831500_B28","doi-asserted-by":"crossref","DOI":"10.1002\/pbc.26370","article-title":"Quantifying bias in survival estimates resulting from loss to follow-up among children with lymphoma in Malawi","volume":"64","author":"Stanley","year":"2017","journal-title":"Pediatr Blood Cancer"}],"container-title":["Blood Advances"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/ashpublications.org\/bloodadvances\/article-pdf\/3\/4\/612\/1631133\/advances029199.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/ashpublications.org\/bloodadvances\/article-pdf\/3\/4\/612\/1631133\/advances029199.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,2,11]],"date-time":"2020-02-11T08:59:42Z","timestamp":1581411582000},"score":1,"resource":{"primary":{"URL":"https:\/\/ashpublications.org\/bloodadvances\/article\/3\/4\/612\/246751\/Prospective-study-of-Burkitt-lymphoma-treatment-in"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,2,22]]},"references-count":28,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2019,2,26]]}},"URL":"https:\/\/doi.org\/10.1182\/bloodadvances.2018029199","relation":{},"ISSN":["2473-9529","2473-9537"],"issn-type":[{"value":"2473-9529","type":"print"},{"value":"2473-9537","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,2,22]]}}}