Background
Globally, pediatric cancer incidence is estimated at 155.8 per million person-years, with lymphomas constituting about 15.5% of all cases.Studies have shown that the use of rituximab in treating Burkitt’s Lymphoma (BL) in children has resulted in significant improvements in event-free survival and lower odds of experiencing a disease-related event compared to standard chemotherapy alone.However, most children diagnosed with BL live in low- and middle-income countries (LMICs), where limited resources and access to essential medicines like rituximab contribute to inferior outcomes.
Objective
To understand the current global availability of rituximab for children and adolescents and explore disparities in access across different institutions across the world to inform efforts to improve access to rituximab for children diagnosed with BL globally. 
Methods
The International Society of Pediatric Oncology (SIOP) Essential Medicines Working Group conducted a global survey to understand global access to rituximab for children with cancer. A survey link was distributed to all SIOP members worldwide through email. Reminders were shared through multiple channels, including weekly bulletins, SIOP CONNECT, and walk-in slides displayed during the 2024 SIOP Congress; continental presidents were also contacted via email. The survey covered respondent demographics, rituximab availability status at each institution, the rituximab brand available, mechanisms of payment, what barriers to access for children with cancer exist, and the availability of subcutaneous rituximab at each institution. Data was descriptively analysed to compare frequencies and proportions using Excel. 
Results
263 complete responses representing 87 countries across five continents were included in the data analysis.  Among respondents, 83% reported rituximab use at their institutions, 13% lacked access (primarily from Africa 52% , Asia 23%, and South America 23%), and 3% were uncertain. Common brands reported were MabThera (Roche), Rixathon (Sandoz-Novartis), Rituxan (Genentech/Biogen), Riabni (Amgen,Inc), and Reditux (Dr. Reddys Laboratories), though many institutions were unaware of the brand used. Public health insurance was reported as the main funding source by 75% of respondents, followed by patient out-of-pocket payments (27%), private insurance (22%), and support from non-governmental organizations (14%). The main barriers to rituximab access were public financing and pricing mechanisms (each cited by 37% of respondents), as well as procurement and supply processes (18%). Use of subcutaneous rituximab was rare, reported by only 1% of institutions.
Conclusion
This survey revealed substantial differences in access to rituximab for children with BL, with notable gaps in availability, particularly in LMICs, including countries such as Cameroon where BL incidence is the highest. Most institutions rely on public health insurance to purchase rituximab. Public financing and pricing mechanisms remain major barriers to access. There is limited use of subcutaneous rituximab globally. Future efforts to address these barriers and associated policy implications are needed to ensure that all children and adolescents diagnosed with BL have access to rituximab.