Burkitt Lymphoma in Liberian children: Clinical outcomes and barriers to care
Rebecca Cook, MD, MSc
BACKGROUND: Overall survival for pediatric cancer in children in Africa is much lower than high income countries due to limited access to timely diagnosis and treatment. Endemic Burkitt Lymphoma (eBL) is the most common childhood cancer in equatorial Africa with an average incidence of 2-5 per 100,000 children, risk factors for eBL include early Epstein Barr Virus (EBV) infection and chronic malaria exposure.
GAP: The characteristics and treatment outcomes of children with endemic Burkitt Lymphoma in Liberia has never been reported, including whether serum EBV viral load may serve as a predictive biomarker. It is unknown whether health systems delays or health-seeking factors contribute the most to delays in diagnosis.
HYPOTHESIS: We hypothesize that EBV viral load and genotype may serve as a prognostic and predictive biomarker for eBL in settings with limited access to pathologist. We also hypothesize that health system delays contribute more than guardian delays in the total delay to diagnosis with eBL.
METHODS: This is a observational mixed methods study recruiting children age 0-15 years from three hospitals in Liberia. Through a combination of clinical data collection, interviews and lab analysis we will report baseline characteristics, delays in diagnosis, barriers to care and examine the EBV viral loads and report treatment outcomes.
RESULTS: Baseline data from our retrospective review of 31 patients diagnosed with eBL over 18 months reveals that most children (87%) are presenting with advanced stage disease and many (35%) are receiving the diagnosis but are unable to receive treatment due to costs. Of those treated with chemotherapy, 33% died during chemotherapy, 33% survived chemotherapy but then relapsed within 1 year, only 5% are known alive and in remission and the remainder (29%) were lost to follow-up.
IMPACT: Our project will inform the Liberian ministry of health and hospitals involved in pediatric cancer care by describing the burden of eBL in Liberian children, barriers to care and providing relevant clinical outcomes that can directly inform care. We will also generate preliminary data on the role of EBV as a biomarker for eBL which could be followed by further validation studies.