ABCL-136: Early Deaths in Childhood Burkitt's Lymphoma: A Major Challenge in Developing Countries

Context: The outcome of childhood Burkitt's lymphoma (BL) has improved steadily over the past decades through the use of intensive sequential multi-agent chemotherapy regimens with increased concern about increasing toxicity-related mortality. Objective: This study objective was to assess incidence and risk factors of early mortality in BL. Design/Setting: A retrospective study included all patients 18 years old or younger diagnosed with BL and treated according to the modified LMB 96 protocol at National Cancer Institute, Cairo University from January 2012 to December 2016. Patients or other participants: A total of 170 patients were diagnosed with BL, with a median age of 5 years old. Abdominal presentation was the most common primary site (90.0%). Sixty-two (36.5%) patients were diagnosed as early as less than or equal to 2 weeks and 108 (63.5%) patients were diagnosed beyond 2 weeks from onset of symptoms. A total of 82 (48.2%) patients presented by disease-related emergencies, 49 patients (59.7%) of them with acute renal impairment due to TLS, and 33 (40.2%) had intestinal obstruction and/or complications. Main outcome measures: Total and early deaths (during reduction and 1st induction phase of therapy) were measured and the underlying causes of early mortalities were also reported. Results: Throughout the whole treatment duration, 39 (23%) total deaths were reported and 50% of them (n=19) died before 2nd induction (early mortality). Eleven patients (57.8%) of them died in the first week, 6/11 patients died before completing the 1st CVP. The main causes of early mortalities were sepsis in 58% and acute renal failure due to TLS in 42% of cases. The 5-year overall survival (OS) and event-free survival (EFS) were 82.9% and 82.8%, respectively for the whole group. Conclusions: Early deaths and treatment-related toxic mortalities remain the major challenge affecting outcome in our patients. Early diagnosis and enhanced supportive care measures are essential to improve the outcome for those group of patients.