Introduction: Burkitt lymphoma (BL) is an aggressive B-cell lymphoma, representing 30%–40% of childhood non-Hodgkin lymphomas globally. In Peru, Epstein–Barr virus (EBV) is highly prevalent in lymphomas, yet its role in paediatric BL remains underexplored.

Objective: This study evaluates the clinical and epidemiological characteristics of paediatric BL at the National Institute of Neoplastic Diseases, focusing on EBV-positive cases, pathological features, treatment response and prognostic factors, within the real-world setting of a lower-middle-income country (LMIC).

Materials and methods: From 2009 to 2021, 187 aggressive B-cell lymphomas were diagnosed in children, from which 34 high-grade B-cell lymphomas underwent central pathology review, yielding 23 molecularly confirmed sporadic BL cases. Inclusion criteria comprised age <15 years, availability of tumour tissue for immunohistochemical analysis and available clinical records.

Results: EBV infection was detected using EBV-encoded RNA (EBER) in situ hybridisation, and MYC translocation (8q24) was identified via FISH. Among the subset, 61% were EBV-positive, with males comprising 65% and a mean age of 6.7 years. EBV-positive status and younger age were associated with inferior survival in univariate analyses (log-rank p = 0.012 and p = 0.009, respectively). The association with EBV was attenuated after exploratory adjustment (HR, 3.69; 95% CI, 0.35–38.98; p = 0.278).

Conclusion: In this cohort, 61% of paediatric sporadic BL cases were EBV-positive, associated with younger age (p = 0.01) and inferior survival in univariate analysis (log-rank p = 0.012). The independent prognostic contribution of EBV could not be established. These LMIC findings support expanded molecular diagnostics and larger multicentre studies.