Burkitt lymphoma (BL) is the most common pediatric cancer in sub-Saharan Africa and is associated with Epstein-Barr Virus (EBV). In a proof of principle study, we demonstrated increased EBV viral particles in tumor biopsies after the first dose of cyclophosphamide, suggesting that the virus had converted to a lytic infection. During the lytic cycle, EBV expresses proteins that make it susceptible to antiviral therapy. In a phase I study of pediatric patients with Burkitt lymphoma, we found that combination therapy with CPM and valacyclovir had a comparable safety profile to CPM monotherapy in children with endemic Burkitt lymphoma. We recommend that the valacyclovir recommended Phase II dose be 30 mg/kg, 3 times daily. We are currently seeking funding for this phase II trial.
D Olson, ML Gulley, W Tang, C Wokocha, O Mechanic, SH Gold, N Nguluwe, C Mwansambo, C Shores (2013). Phase I clinical trial of valacyclovir and standard of care cyclophosphamide in children with endemic Burkitt lymphoma in Malawi. Clinical Lymphoma, Myeloma, and Leukemia, 13(2):112-118.
W Tang, P Harmon, ML Gulley, C Mwansambo, PN Kazembe, F Martinson, C Wokocha, SC Kenney, I Hoffman, C Sigel, S Maygarden, M Hoffman, C Shores (2010). Viral response to chemotherapy in endemic Burkitt lymphoma. Clinical Cancer Research, 16(7):2055-2064.