These researchers have dedicated their careers to finding new treatments and cures for people with cancer.
In most parts of the world, Burkitt lymphoma is a less common childhood cancer. But in sub-Saharan African countries like Malawi, this aggressive, fast-growing blood cancer is endemic1—not to mention even more deadly.
Even under the best possible circumstances—ready access to healthcare, economic stability, no preexisting conditions—treatments for Burkitt lymphoma can be debilitating, with side effects including sepsis, anemia, mucositis, and febrile neutropenia. For pediatric patients in Malawi—where more than 1 million children suffer from chronic malnutrition—the outlook grows even more dire: Indeed, many young patients die just days after receiving chemotherapy, largely due to illness from treatment-related side effects.
Between the already-debilitating side effects and the added complication of malnutrition, the need for carefully tailored oncology care is significant. It’s a complex set of problems that pediatric oncologist and physician-scientist Rizine Mzikamanda is actively addressing through research, with support from a 2023 Young Investigator Award from Conquer Cancer, the ASCO Foundation.
In Africa, a Common Cancer with a Deadly Disparity
Burkitt lymphoma is significantly less common in North America, and it also tends to be significantly less fatal. In the U.S., children with this disease have a more than 80% survival rate. In African countries, however, the rate is around 40%.
“Conquering cancer,” Dr. Mzikamanda explains, “means a child with Burkitt lymphoma in Africa should have an equal chance of survival as a child with the same disease in the U.S.”
Determined to close the gap—and enhance cancer care for patients everywhere—Dr. Mzikamanda is assessing the feasibility of a treatment protocol that accounts both for treatment side effects and the unique needs of local populations. The outcome, he hopes, will be a supportive care strategy that better addresses the treatment challenges and disparities experienced by patients throughout Malawi and neighboring African countries.
In Malawi, for example, many patients with Burkitt lymphoma receive too little chemotherapy compared to the recommended guidelines. Dr. Mzikamanda’s supportive care strategy, however, aims not only to ensure patients receive the optimal amount of chemotherapy, but also to mitigate the severity of its side effects. This approach, he explains, can help patients to safely and successfully finish high-dose and intensive chemotherapy in a timely manner, with minimal risk of relapse and life-threatening side effects.
“We know which treatments work best, which side effects are common, and how to administer the therapies,” Dr. Mzikamanda says. "The focus is really on making sure it's done in a safe and effective way. If supportive care strategies are implemented to help children with Burkitt lymphoma in African settings to better manage the side effects of treatment, then our patients are much likelier to complete treatment and reach better outcomes in the long term.”
Shaping a Supportive Care Strategy
Last year, using his Conquer Cancer funding, Dr. Mzikamanda and his team launched a clinical study testing the effectiveness of high-dosage chemotherapy administered in tandem with a locally developed supportive care strategy. Their work included a comprehensive review of supportive care studies to identify the most common side effects that patients with Burkitt lymphoma face during chemotherapy.
“This study,” Dr. Mzikamanda says, “enabled us to assess the overall impact on long-term survival of children with Burkitt lymphoma in our setting and identify which patients may be in need of supportive care the most.”
Over the course of this research, Dr. Mzikamanda and his colleagues found that children with high-risk Burkitt lymphoma—particularly those whose cancer has spread to their bone marrow or central nervous system—experienced earlier, more frequent relapses compared to those without high-risk disease. He found that these patients needed individualized supportive care measures to improve their chance of durable remission.
Using these data, Dr. Mzikamanda developed a supportive care protocol and monitoring using simple and available blood tests for patients undergoing chemotherapy, factoring in the identified common side effect risks to individually personalize care and to allow intensified treatment for patients with high-risk disease. He then trained providers to implement these care regimens during and after treatment.
“As a result, we’re giving a lot more intensive treatment to these children now,” Dr. Mzikamanda says. “We also added another cancer drug, rituximab, to their treatment early on, and we're still observing the impact of this combination treatment. Our team believes this research will ultimately help to improve the survival of these children and reduce their risks for relapse.”
When one young patient with severe malnutrition first visited his clinic, Dr. Mzikamanda knew he needed highly nuanced treatment and supportive care. Therapies for Burkitt lymphoma and other blood-related cancers are notoriously taxing, and malnourished patients often find treatment even more so. However, little research exists investigating how chemotherapy affects malnourished children in African settings.
“We do not yet fully understand how standard treatments work in malnourished children from our local populations because most studies in this research area have been based in the U.S. and Western Europe,” Dr. Mzikamanda explains. “We had to take all of this into account when forming my patient’s treatment approach, helping to ensure a delicate balance of highly toxic drugs while maintaining his safety and preventing side effects.”
Mitigating Treatment Abandonment and Helping Patients Stay the Course
Further complicating care and outcomes for patients with Burkitt lymphoma is the high rate of treatment abandonment in sub-Saharan Africa—particularly in isolated regions without accessible cancer clinics. In other cases, families may discontinue treatment because of costs or patient-provider communication challenges.
When the mother of Dr. Mzikamanda’s patient first brought her son for care, she struggled to understand the complexities of his treatment regimen, causing concern that his family would ultimately abandon treatment.
Against the odds, however, the family returned, and the child completed the full course of care. “We believe that because of our research,” Dr. Mzikamanda says, “we were able to effectively communicate with the mother, and she better understood why we were making these recommendations and taking unique approaches to her son’s treatment.”
Following a tailored treatment regimen and supportive care individualized to a limited resource African setting, Dr. Mzikamanda’s patient achieved a complete remission of his disease. This and other similar outcomes have ignited new ideas for future research to better understand the effects of treatment on severely malnourished children with Burkitt lymphoma.
“If we can improve our knowledge in this area,” says Dr. Mzikamanda, “we can more effectively adjust their treatments based on the severity of malnourishment and help to prevent side effects accordingly.”
A Promising Future for Burkitt Lymphoma Research—and the Patients at its Heart
The next steps in Dr. Mzikamanda’s research include further optimizing therapies for Burkitt lymphoma in children, both in Malawi and worldwide. He intends to explore the role of heredity and biology, particularly for patients in Malawi and other countries of sub-Saharan Africa.
“We want to investigate the genetic aspects of the disease,” Dr. Mzikamanda says, “because these have not been described adequately in the African population.”
Given their findings around patients with high-risk disease and the need for more personalized treatment, his team also wants to develop a system for monitoring the effectiveness of novel treatment combinations and to further refine the supportive care strategies tested in their Conquer Cancer-funded study.
“In Malawi, where resources are limited but patients abound, cancer research helps us to build a platform of treatments and supportive care for our patients and develop protocols that other cancer centers in our region can emulate,” Dr. Mzikamanda says. “Supporting research has an immense, tangible impact not only for improved treatment for patients here in African settings, but also for improving equitable care for patients around the world.”
