Publication Only: Aggressive non-Hodgkin lymphoma - Clinical
Many patients with Burkitt lymphoma has rapid tumor regression following administration of chemotherapeutic drugs. However, while the patients are making “good progress” clinically, some of them suddenly collapse and die.
The aim of this work is to analyze causes of death among pediatric mature B cell NHL, to identify adverse prognostic factors that might put those patients at high risk of mortality at different phases of treatment. And finally, to set a series of recommendation to ameliorate the OS and avoid unexpected treatment related mortality
We conducted a retrospective analysis that included all Burkitt Lymphoma (BL) patients who were diagnosed and treated at CCHE during the period from 06/2012 till end of 12/2018 and died. All patients were treated according to LMB96 protocol, and were stratified as low, intermediate or high risk group. Analysis included epidemiologic data, initial presentation, laboratory and radiologic investigations, tumor stage, risk stratification, direct cause of death, associated co-morbidity and phase of treatment where death occurred.
Out of 570 patients recorded during the study period, 84 (14.7%) died. Majority (69%) were males with mean age 7.6 years. Most of them (94%) had advanced stage (III and IV) disease. Forty eight patients from intermediate (12.2%), and 36 from high risk group (28.3%) died. Majority of patients (78.6%) died in active disease, while 21.4% died in CR/PR. Main causes of death were septic shock (34.5%), disease progression in (31%), tumor lysis syndrome (TLS) (11.9%). Other reported causes of death were sever chest infection (6%), multi-organ failure associated with sepsis (6%), pulmonary hemorrhage (2.4%), neutropenic enterocolitis, GVHD, and gut perforation (1.2%) each. Three patients (3.6%) died upon arrival to the hospital without receiving any kind of chemotherapy, 17 (20.4%) during prephase, 24 (28.5%) during induction, 8 (9.5%) during consolidation, 2 (6.1%) during maintenance phase. For relapsing patients, 18 (21.4%) died from chemotherapy toxicity of second line, while 6 (7.1%) were on palliative care when they died.
Despite being a well-equipped tertiary care hospital dedicated to the management of pediatric malignancies, we report a very high mortality rate in our hospital. Late presentation, TLS and sever sepsis are main causes of death throughout different phases of treatment. For relapsed patient, toxicity of 2nd line chemotherapy and tumor progression are the main causes of death. We need intensify supportive care measures, and to better identify patients at high risk for mortality to avoid unnecessary patients' death.