Dissecting apart the biology of childhood lymphoma in Africa towards improving treatment outcome

We want to understand why children diagnosed with Burkitt lymphoma in Sub-Saharan Africa, the so-called endemic form of this disease, have poor survival outcomes by studying the unique biology of this disease. Whilst social and economic factors undoubtedly play a role, we do not know if the underlying biology differs from that of children diagnosed with sporadic Burkitt lymphoma in high income countries. If we understand the unique biology, we can design better treatment approaches. 

Having determined the biology of endemic Burkitt lymphoma with regards to how the tumour cells respond to treatment, we will be able to inform on treatment approaches. At present, children in the UK are treated with toxic drugs that often require support in intensive care, but survival rates are high – this makes it difficult to try new, less toxic drugs because we don’t want to risk trying something novel and survival not being as good. At the same time, as survival is already greater than 95% despite the toxic side-effects, just adding a new drug to the existing treatment approach is not ideal as it is unlikely to make any significant difference to the patients. In contrast, in Sub-Saharan Africa, children receive chemotherapy at lower doses because they do not have the facilities to care for very sick children.

It is not surprising that this leads to inferior survival outcomes for these children who also often fail to finish treatment due to a number of social and economic factors. In essence, we have a lot to learn from one another and arguably, children in Sub-Saharan Africa stand to benefit more from the identification of new treatment approaches which are less toxic and can perhaps be given as outpatients. In turn, children in the UK may benefit from this approach whereby we may learn which are the best new treatment approaches to trial in high income settings without risking a decrease in survival outcomes.

Whilst this may be some 10 years off, starting now to tease apart the biology of endemic compared to sporadic Burkitt lymphoma will give us some clues as to the best approaches to use in future trials. During this time, we also need to build the infrastructure required to run childhood cancer trials in Africa, work that is ongoing within the international society for paediatric oncology-Africa branch. We anticipate that the results or our research will align with this activity towards implementation.