Optimal management of endemic Burkitt lymphoma: a holistic approach mindful of limited resources

Ann M Moormann,1,* Jodi L Skiles,2,* Juliana A Otieno,3 Geoffrey C Buckle,1 Terry A Vik2 1University of Massachusetts Medical School, Worcester, MA, USA; 2Indiana University School of Medicine, Indianapolis, IN, USA; 3Jaramogi Oginga Odinga Teaching and Referral Hospital, Ministry of Medical Servi...

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Autores principales:	Moormann AM, Skiles JL, Otieno JA, Buckle GC, Vik TA
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2014
Materias:	Diseases of the blood and blood-forming organs RC633-647.5
Acceso en línea:	https://doaj.org/article/e39cc50582904287a2805b2d8eb9dbab
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spelling	oai:doaj.org-article:e39cc50582904287a2805b2d8eb9dbab2021-12-02T03:12:43ZOptimal management of endemic Burkitt lymphoma: a holistic approach mindful of limited resources1179-9889https://doaj.org/article/e39cc50582904287a2805b2d8eb9dbab2014-09-01T00:00:00Zhttp://www.dovepress.com/optimal-management-of-endemic-burkitt-lymphoma-a-holistic-approach-min-peer-reviewed-article-BLCTThttps://doaj.org/toc/1179-9889 Ann M Moormann,1,* Jodi L Skiles,2,* Juliana A Otieno,3 Geoffrey C Buckle,1 Terry A Vik2 1University of Massachusetts Medical School, Worcester, MA, USA; 2Indiana University School of Medicine, Indianapolis, IN, USA; 3Jaramogi Oginga Odinga Teaching and Referral Hospital, Ministry of Medical Services, Kisumu, Kenya *These authors contributed equally to this work Abstract: Endemic Burkitt lymphoma (BL) was publically described in 1958 and remains the most prevalent pediatric cancer in equatorial Africa with an annual incidence between two and five cases per 100,000 children. Several risk factors have been identified, including early-age infection with Epstein–Barr virus, a geographic association with high Plasmodium falciparum malaria transmission, and poor nutrition. However, other modifiable factors play a role in the survival of these children. Treatment regimens for BL have evolved over a time period that spans nearly 50 years. This review will compare survival between different combination chemotherapeutic regimens and discuss other key determinants of outcomes among children diagnosed with BL in resource-limited settings. A discussion of obstacles to diagnosis will be presented, including low community awareness of pediatric cancer, limited access to health facilities, inaccurate or delayed diagnosis often beginning at lower level health rural facilities that are typically staffed by those with limited training in oncology, and insufficient pathology support to confirm diagnosis. Other challenges examined here include those related to treatment adherence, specifically the social and economic stressors that can lead to abandonment of care, and treatment-related toxicity, a challenge compounded not only by the scarcity of medications for supportive care, but also the paucity of clinically trained medical professionals available to manage integrated care for these children. Future directions for enhancing BL survival will be discussed including molecular approaches for rational drug discovery as well as the benefits of forming a unified, global BL research network. Keywords: pediatric cancer, treatment regimen, Africa, social and economic predictors, biomarkersMoormann AMSkiles JLOtieno JABuckle GCVik TADove Medical PressarticleDiseases of the blood and blood-forming organsRC633-647.5ENBlood and Lymphatic Cancer: Targets and Therapy, Vol 2014, Iss default, Pp 91-99 (2014)
institution	DOAJ
collection	DOAJ
language	EN
topic	Diseases of the blood and blood-forming organs RC633-647.5
spellingShingle	Diseases of the blood and blood-forming organs RC633-647.5 Moormann AM Skiles JL Otieno JA Buckle GC Vik TA Optimal management of endemic Burkitt lymphoma: a holistic approach mindful of limited resources
description	Ann M Moormann,1,* Jodi L Skiles,2,* Juliana A Otieno,3 Geoffrey C Buckle,1 Terry A Vik2 1University of Massachusetts Medical School, Worcester, MA, USA; 2Indiana University School of Medicine, Indianapolis, IN, USA; 3Jaramogi Oginga Odinga Teaching and Referral Hospital, Ministry of Medical Services, Kisumu, Kenya *These authors contributed equally to this work Abstract: Endemic Burkitt lymphoma (BL) was publically described in 1958 and remains the most prevalent pediatric cancer in equatorial Africa with an annual incidence between two and five cases per 100,000 children. Several risk factors have been identified, including early-age infection with Epstein–Barr virus, a geographic association with high Plasmodium falciparum malaria transmission, and poor nutrition. However, other modifiable factors play a role in the survival of these children. Treatment regimens for BL have evolved over a time period that spans nearly 50 years. This review will compare survival between different combination chemotherapeutic regimens and discuss other key determinants of outcomes among children diagnosed with BL in resource-limited settings. A discussion of obstacles to diagnosis will be presented, including low community awareness of pediatric cancer, limited access to health facilities, inaccurate or delayed diagnosis often beginning at lower level health rural facilities that are typically staffed by those with limited training in oncology, and insufficient pathology support to confirm diagnosis. Other challenges examined here include those related to treatment adherence, specifically the social and economic stressors that can lead to abandonment of care, and treatment-related toxicity, a challenge compounded not only by the scarcity of medications for supportive care, but also the paucity of clinically trained medical professionals available to manage integrated care for these children. Future directions for enhancing BL survival will be discussed including molecular approaches for rational drug discovery as well as the benefits of forming a unified, global BL research network. Keywords: pediatric cancer, treatment regimen, Africa, social and economic predictors, biomarkers
format	article
author	Moormann AM Skiles JL Otieno JA Buckle GC Vik TA
author_facet	Moormann AM Skiles JL Otieno JA Buckle GC Vik TA
author_sort	Moormann AM
title	Optimal management of endemic Burkitt lymphoma: a holistic approach mindful of limited resources
title_short	Optimal management of endemic Burkitt lymphoma: a holistic approach mindful of limited resources
title_full	Optimal management of endemic Burkitt lymphoma: a holistic approach mindful of limited resources
title_fullStr	Optimal management of endemic Burkitt lymphoma: a holistic approach mindful of limited resources
title_full_unstemmed	Optimal management of endemic Burkitt lymphoma: a holistic approach mindful of limited resources
title_sort	optimal management of endemic burkitt lymphoma: a holistic approach mindful of limited resources
publisher	Dove Medical Press
publishDate	2014
url	https://doaj.org/article/e39cc50582904287a2805b2d8eb9dbab
work_keys_str_mv	AT moormannam optimalmanagementofendemicburkittlymphomaaholisticapproachmindfuloflimitedresources AT skilesjl optimalmanagementofendemicburkittlymphomaaholisticapproachmindfuloflimitedresources AT otienoja optimalmanagementofendemicburkittlymphomaaholisticapproachmindfuloflimitedresources AT bucklegc optimalmanagementofendemicburkittlymphomaaholisticapproachmindfuloflimitedresources AT vikta optimalmanagementofendemicburkittlymphomaaholisticapproachmindfuloflimitedresources
_version_	1718401892296425472

Optimal management of endemic Burkitt lymphoma: a holistic approach mindful of limited resources

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