Biochemical indices of Burkitt's Lymphoma clinial relevance in prognosis and management

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Endemic Burkitt’s lymphoma (eBL) is a juvenile malignant neoplasm of B-lymphocyte origin, markedly affected by climate, vegetation and geographical location. All outpatient clinical records of patients histologically and/or clinically diagnosed of BL from January, 2000 to December, 2007 at the Komfo Anokye Teaching Hospital, Ghana, a country within the malaria and lymphoma belts of the world, were reviewed in a real country-based cross-sectional retrospective study. The effect of cyclical chemotherapy (Cyclophophamide, Vincristine, Methotrexate and Prednisolone) on serum lactate dehydrogenase (LDH), creatinine (Crt), sodium (Na), potassium (K), phosphorus (Phos), calcium (Ca), chloride (Cl) and uric acid (UA) in relation to treatment outcome in 76 newly diagnosed BL patients was also studied in a longitudinal prospective study . A mean age of 6.9 2.7 (mode: 7; range: 1-16) was observed. Males generally dominated in incidence (M: F= 1.43:1, p< 0.001) and significantly with facial presentation (p<0.05). Females weakly dominated in abdominal presentations (p>0.05). Age 4-8 years was the high risk range (p< 0.001) for both sexes. Males were affected early in life (4-7 years) compared to their female counterparts (6- 11 years). Of the 551 cases reviewed, 48.3%, 32.7%, 15.8% and 3.3% were tumour presentation(s) involving the face, abdomen, combined facial and abdominal and either facial or abdominal with central nervous system (CNS) involvement (usually paraplegia) respectively. An intriguing observation was evident between facial and combined facial and abdominal cases which exhibited direct reverse trends in incidence. Three regions within the forest zone individually showcased significantly higher (p< 0.001) incidences compared to their seven cohorts that constitute the coastal and savannah agro-ecological zones of Ghana. No region was explicitly associated with any particular clinical presentation. In addition to LDH and tumour stage which are known prognostic factors for high-grade XV non-Hodgkin’s lymphomas (NHLs), Crt (p< 0.001) and Cl (p= 0.039) were also identified as independent prognostic factors for eBL with respect to overall survival (OS) and were subsequently used in hazard modelling. LDH, Na and Ca showed significant (p<0.05) changes during cyclical chemotherapy within treatment time points and in comparism with healthy age-sex matched controls. Post intensive-treatment outcome was found to the associated with the trend of serum LDH, UA, Na, K and Ca after a three-month monitoring period. This study has shown that though BL can present with demographic patterns in prevalence within a given geographical location, no clinical characterisation can necessarily be found associated with such patterns. However, serum LDH, Crt, Cl and tumour stage can serve as important prognostic factors before chemotherapy, and serum LDH, UA, Na and K can be used for monitoring of cyclical chemotherapy to enhance OS in eBL.
A Thesis submitted to the Department of Biochemistry and Biotechnology, Kwame Nkrumah University of Science and Technology in partial fulfilment of the requirements for the degree of MASTER OF PHILOSOPHY Faculty of Biosciences College of science