Clinical characteristics and outcome analysis of pediatric B-cell non-Hodgkin's lymphoma. Experience with FAB-LMB 96 and UKCCSG B-cell NHL guidelines in a developing country

Aim: To analyze the clinical characteristics of B-cell non-Hodgkin's lymphoma (NHL) patients and the therapeutic efficacy of French-American-British Lymphoma Malins de Burkitt 96 and the recent United Kingdom Children's Cancer Study Group B-cell NHL guidelines in the tertiary care hospital of a developing country. Methods: Patients aged ≤18 years registered at our hospital between January 1995 and December 2006 with histologically proved B-Cell NHL were selected for retrospective analysis. Results: Of the total of 131 patients registered, 122 patients were eligible for evaluation. Of these 95 had Burkitt's lymphoma, 22 diffuse large B-cell lymphoma and five had B-cell NHL not otherwise specified. The mean age was 8.4 years. Overall 42 children had a baseline weight less than the 10th centile. A total of 37 had uric acid >10 mg/dl and 55 had a lactate dehydrogenase level >500; 73 had stage III and 31 had stage IV while only four presented at stage I and 14 at stage II. The abdomen was the commonest site of disease. A total of 45 patients died; 28 due to infection, nine due to tumor lysis syndrome and six of uncontrolled disease. All deaths occurred within an average of 35 days from starting treatment. Our 5-year overall survival rate was 68 percent and our event-free survival was 55 percent. Conclusion: Late presentation with advanced disease, poor nutritional status and high risk of exposure to infective agents all contribute to the high mortality in patients treated with intensive protocols in resource-poor countries.