Childhood Burkit Lymphoma: The Treatment Outcomes, Survival Rates, and Predictors of Mortality at Two Tertiary Hospitals in Tanzania

Childhood Burkit Lymphoma: The Treatment Outcomes, Survival Rates, and Predictors of Mortality at Two Tertiary Hospitals in Tanzania | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Childhood Burkit Lymphoma: The Treatment Outcomes, Survival Rates, and Predictors of Mortality at Two Tertiary Hospitals in Tanzania Hajji Nkya, Aisa Shayo, Dennis Machaku, Blandina Mmbaga, Grace Kinabo, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7810619/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Background : Burkitt lymphoma (BL) is an aggressive B-cell lymphoma predominantly affecting children in sub-Saharan Africa. It constitutes 50-70% of pediatric non-Hodgkin lymphomas in the region. In Tanzania, understanding the treatment outcomes and one-year survival rates at two major oncology centers can inform strategies to enhance survival. Methodology : This retrospective cohort study analyzed children under 18 diagnosed with Burkitt lymphoma and treated at two tertiary care hospitals between January 2020 and December 2022. The study utilized Stata 18 to analyze data from medical records, focusing on demographic and clinical characteristics, Kaplan-Meier survival analysis, and Cox proportional hazards models to identify mortality predictors. Results : The study analyzed 72 children with Burkitt lymphoma (mean age: 5.8 years), predominantly male (70.8%), with 52.8% from rural areas. Tumor sites were mainly mandibular (47.2%) and abdominal (41.7%). Treatment outcomes varied between hospitals: KCMC had a higher complete remission rate (61.3%) compared to BMC (36.6%), while BMC experienced higher relapse (19.5%) and treatment abandonment rates (22.0%) than KCMC (6.5% and 3.2%, respectively). The one-year post-treatment survival rate was 75% overall, with a significantly longer mean survival time at KCMC (37.1 months) versus BMC (16.4 months). Key predictors of mortality included bone marrow involvement (AHR=32.48) and CNS involvement (AHR=34.00). Conclusion : The study reveals a 75% one-year survival rate for children with Burkitt lymphoma in Tanzania, surpassing the WHO's 2030 target. However, high treatment abandonment, relapse, and death rates, along with low complete remission rates, pose significant challenges. Key factors contributing to poor prognosis include CNS and bone marrow involvement. The study recommends comprehensive interventions, improved care access, and exploring alternative treatments like stem cell transplantation. Burkitt Lymphoma treatment outcomes survival rate Mortality predictors Tanzania Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction Burkitt lymphoma (BL), is an aggressive B cell lymphoma that was first identified as a tumor in African children, affects people all over the world, with its incidence varies noticeably by region and even within regions. Clinically it can be classified into major three groups mainly endemic, sporadic and immunodeficiency-related ( 1 ). The endemic Burkitt lymphoma subtype is most common in equatorial Africa, particularly in areas with high malaria infection rates. It is linked to the Epstein-Barr virus (EBV) and frequently manifests as malignancies in the jaw or facial bones ( 2 ). The sporadic type is found all across the world, primarily affecting children and young people. It is less commonly associated with EBV, and tumors typically develop in the abdomen or other extra nodal locations. The immunodeficiency-associated Burkitt lymphoma subtype primarily affects people with weakened immune systems, such as those with HIV/AIDS or who have had organ transplants ( 3 ). Each subtype of Burkitt lymphoma has a different clinical presentation and prognosis, including endemic, sporadic, and immunodeficiency-associated cases. Malaria and EBV are associated with the endemic type. Burkitt Lymphoma (BL) is a rapidly growing mass with elevated uric acid and lactate dehydrogenase, affecting the abdomen, head, and neck. Symptoms include abdominal distension, nausea, vomiting, gastrointestinal bleeding, and pain. BL can cause periorbital swelling, jaw lesions, and genitourinary issues, especially in children. Diagnosis requires immunocolloidal studies, microscopic evaluation, and excision biopsy, with bone marrow aspiration and biopsy being crucial post-diagnosis. Treatment involves cytogenetics and immunohistochemistry, with cancerous B-cells showing IgM, positive markers, and positive CD10 and bcl-6 markers ( 4 , 5 ). In 2018, global cancer statistics highlighted a significant burden, with an estimated 9.6 million cancer-related deaths and 18.1 million new cases. Among these, non-Hodgkin lymphoma, including Burkitt Lymphoma (BL), constituted approximately 2.8% of all cancer cases and 2.6% of cancer deaths, amounting to 500,000 cases and 250,000 deaths, respectively ( 6 ). Over 400,000 children worldwide are diagnosed with cancer annually, with 80% in low- and middle-income countries. In the US, BL incidence declined, but Africa saw 3,900 new cases ( 7 – 9 ). The incidence of BL in Africa varies significantly, with northern Uganda and Tanzania experiencing the highest rates, ranging from 2 to 15 cases per 100,000 children, while Kenya has an average annual rate of 0.61 per 100,000. Between 2000 and 2010, incidence patterns in northern Tanzania remained consistent ( 10 ). HIV and organ transplantation are linked to immunodeficiency-related variation, with distinctive morphology and chromosomal rearrangement involving the MYC oncogene unifying all patients with BL. The disease causes over half of all childhood malignancies in endemic areas and 40% to 50% of childhood non-Hodgkin's lymphomas in non-endemic areas ( 11 , 12 ). The sporadic subtype of BL is common in the United States and Western Europe, with an annual incidence of three cases per million people in the general population, where it contribute to 30% of all pediatric lymphomas, with a peak prevalence around the age 10 ( 3 ). The precise global incidence of BL is unknown since collecting of these sorts of epidemiologic data is hampered by a lack of resources required for case identification and correct diagnosis in underdeveloped countries with the highest apparent incidence such as equatorial Africa ( 8 ). Burkitt's lymphoma patients are managed as emergencies, with supportive care, electrolyte imbalances, and risk-adapted strategies, including short-term, dose-intensive chemotherapy, extended hospital stays, and strong blood product support ( 13 – 15 ). Research indicates that children with intermediate and high-risk diseases need high-intensity cytotoxic chemotherapy to fully recover from BL. However, pediatric centers in Sub Saharan Africa struggle to provide supportive care for administering current gold standard regimens. In Blantyre, Malawi, a regimen with vincristine and cyclophosphamide with Methotrexate produced a poor 1-year EFS and high TRM ( 16 ). Combination chemo-immunotherapy using agents like R-hyper-CVAD, CODOX-M/IVAC +/- R, dose-adjusted EPOCH-R, R-IVAC, R-GDP, R-ICE, and DHAP are salvage regimens for refractory or relapsed disease ( 16 – 19 ). Although aggressive chemotherapy and supportive care can cure more than 90% of B-cell lymphomas diagnosed in affluent countries ( 20 , 21 ). Chemotherapy is the most popular treatment for bone marrow leukemia (BL), with various medication combinations including vincristine, doxorubicin, prednisolone, and cyclophosphamide. Prednisolone is used to delay emesis and G-CSF is used to accelerate white blood cell synthesis. Rituximab is increasingly used to improve patient outcomes. However, chemotherapy has both short-term and long-term side effects, including alopecia, nausea, vomiting, bone marrow suppression, and a decline in quality of life. Monitoring these side effects is crucial to reduce morbidity and death ( 4 , 22 , 23 ). Modern treatment for BL treatment is more effective in high-income countries due to early detection programs, multimodal therapies, and diagnostics. In Turkey, 72% of children had complete remissions, while 22% died in hospital ( 24 , 25 ). In East Africa, 78% of children with eBL completed six rounds of chemotherapy, with 31% surviving without events, 16% relapsing, and 31% lost to follow-up ( 20 ). Burkitt lymphoma (BL) in children varies across countries, with less than 50% in certain African LMICs and over 90% in high-income nations. Factors such as age, stage of diagnosis, socioeconomic situation, lack of resources, and comorbidities like hunger hinder survival in underdeveloped nations ( 24 ). In the US, a 5-year relative survival rate of 90.4% was reported for 797 pediatric BL patients under 15, while in Sub-Saharan Africa, a 60% overall survival rate was observed. In Malawi, 73 children under 18 were diagnosed with BL, with 66% being male and 2 testing positive for the virus. In East Africa, a 45% overall one-year survival rate was reported for 428 children with endemic BL. In Tanzania, a 50.2% overall survival rate was observed among 109 children receiving treatment ( 20 , 26 ). Burkitt lymphoma (BL) survival rates vary, with less than 50% in certain African LMICs and over 90% in high-income nations. Factors like age, stage of diagnosis, socioeconomic situation, lack of resources, and comorbidities like hunger hinder survival in underdeveloped nations. In the US, a 5-year relative survival rate of 90.4% was reported, while in Sub-Saharan Africa, a 1-year overall survival rate of 60% was reported. Long-term survival rates in Africa are much lower ( 27 – 30 ). A study in Egypt observed factors like bone marrow and CNS involvement linked to worse outcomes in children with Burkitt lymphoma ( 31 ). A Kenyan research study saw that low hemoglobin and high LDH were linked to increased death risk. Anemia and malarial infection had a mortality rate of 1.10–11.44, which was 3.55 times lower in anemic children with malaria. EBV load was not related to survival or different depending on tumor stage ( 20 ). It is noted that, poor outcomes in children with Burkitt lymphoma (BL) in developing countries are attributed to factors such as; lack of chemotherapy supplies, abandonment, toxicities, and delays in diagnosis. Despite the ongoing research to depict the most effective regimens and biomarkers, the consensus on the best regimen and biomarkers remains unresolved. This study aims at delineating the treatment outcomes, one-year post-treatment survival rate and predictors of mortality in childhood Burkitt lymphoma at two tertiary hospitals in Tanzania. Materials and methods This retrospective cohort study was conducted at Kilimanjaro Christian Medical Center (KCMC) and Bugando Medical Center (BMC) in Tanzania, examining records of children treated for Burkitt lymphoma (BL) between January 1, 2020, and December 31, 2022. The research, which spanned from July 2023 to July 2024, involved analyzing data from the oncology and histopathology departments at both centers. The study aimed to assess BL treatment outcomes and involved the formulation of the proposal, data collection, analysis, and report writing within the one-year timeframe. The study focused on children under 18 with confirmed Burkitt lymphoma (BL) who began treatment at the pediatric oncology departments of KCMC and BMC between January 1, 2020, and December 31, 2022. Participants were followed for one year, up to December 31, 2023, to assess survival rates. The study included only those with histologically confirmed BL who received treatment within the specified period and excluded patients with unconfirmed BL or those who presented with recurrence. Data collection and analysis methods Data were collected using a comprehensive extraction sheet covering sociodemographic information, clinical characteristics, laboratory findings at diagnosis, and one-year treatment outcomes. Patient file numbers that met the inclusion criteria were retrieved from the oncology registry system and used to access both electronic and physical medical records, excluding those with unconfirmed histological diagnoses of Burkitt lymphoma. The study evaluated dependent variables including treatment outcomes such as complete remission, relapse, progressive disease, treatment abandonment, and death, as well as one-year post-treatment survival rates categorized as alive, dead, or lost to follow-up. Survival time was measured continuously in months and summarized with mean and confidence intervals. Independent variables assessed included demographic factors (age, sex, residence location, distance to treatment facility, family size, insurance coverage), clinical characteristics (tumor site, risk classification, CNS and bone marrow involvement), treatment details (treatment facility, time from diagnosis to treatment start), and laboratory findings at diagnosis (hemoglobin, uric acid, LDH, platelet count, ESR). Data analysis methods Statistical analyses were performed using Stata 18. Descriptive statistics were employed to summarize the study population's background characteristics. Numerical variables, such as age, were described using means and standard deviations, while categorical variables, including sex, location of residence, health insurance status, treatment facility, tumor site, risk classification, CNS involvement, and bone marrow involvement, were summarized with frequencies and percentages. Results There were 138 patients with diagnosis of BL in total at KCMC and BMC ,66 patients were excluded from analysis due to following reasons diagnosis changed to other cancers, missing files, death before finishing treatments [ Figure 1 ]. In this study of 72 children with Burkitt Lymphoma (BL), the majority were boys (70.8%), with similar proportions at KCMC (71.0%) and BMC (70.7%). Most children were under 5 years old (51.8% overall; KCMC 58.1%, BMC 46.3%). A significant portion resided in rural areas (52.8%; KCMC 51.6%, BMC 53.7%). Larger families, with more than four children, were more common overall (59.3%), particularly at BMC (70.7%), whereas smaller families were more frequent at KCMC (58.1%). Most children lacked health insurance (73.6%), a trend consistent at both KCMC (74.2%) and BMC (73.2%) [ Table 1 ]. Table 1 Background characteristics of children with (N = 72) Hospital Characteristics KCMC n = 31(%) BMC n = 41 (%) Total N = 72 (%) Age (years) < 5 18(58.1) 19(46.3) 37(51.84) 6–10 9(29.) 18(43.9) 27(37.5) 11–18 4(12.9) 4(9.8) 8(11.1) Sex of a child Male 15(71.0) 19(70.7) 51(70.8) Female 16(29.0) 22(29.3 21(29.2) Location of resident Urban 15(48.4) 19(46.3) 34(47.2) Rural 16(51.6) 22(53.7) 38(52.8) Number of children in the family ≤ 4 18(58.1) 12(29.3) 30(41.7) > 4 13(41.0) 29(70.7) 42(59.3) Health Insurance No 23(74.2) 30(73.2) 53(73.6) Yes 8(25.8) 11(26.8) 19(26.4) The mandibular region was the most common tumor site among the children with Burkitt Lymphoma (BL), affecting 47.2% of cases overall, with a higher prevalence at KCMC (67.7%) compared to BMC (31.7%). Abdominal masses were more common at BMC (58.5%) than at KCMC (29.0%). Other tumor sites, such as the retro-orbital region and testicular area, were less frequent. High-risk stage at diagnosis was noted in 63.9% of cases, with a higher proportion at KCMC (71.0%) compared to BMC (58.5%). CNS involvement was more common at KCMC (16.1%) and bone marrow involvement was higher at BMC (36.6%). Most children began treatment within two weeks of diagnosis (94.4%), with 100% at BMC and 87.1% at KCMC starting within this timeframe [ Table 2 ]. Table 2 Clinical-pathological characteristics of Children with BL (N = 72) Hospital Characteristics KCMC n = 31(%) BMC n = 41(%) Total n = 72 (%) Site of the tumor Mandibular 21(67.7) 13(31.7) 34(47.2) Retro-orbital 1(3.2) 3(7.3) 4(5.6) Abdominal mass 9(29.0) 24(58.5) 33(45.8) Testicular 0(0.0) 1(2.4) 1(1.4) BL stage at diagnosis High risk (Group B) 22(71.0) 24(58.5) 46(63.9) CNS present (Group C) 5(16.1) 2(4.9) 7(9.7) Bone marrow (Group D) 4(12.9) 15(36.6) 19(26.4) Time from diagnosis to treatment (weeks) ≤ 2 weeks 27(87.1) 41(100) 68(94.4) > 2 weeks 4(12.9) 0(0.0) 4(5.6) BL-Burkitt Lymphoma CNS-Central Nervous System Laboratory findings of children with Burkitt lymphoma Laboratory evaluations revealed that an elevated Erythrocyte Sedimentation Rate (ESR) (> 10), indicating an inflammatory response, was observed in 94.4% of patients, with similar high rates at KCMC (96.8%) and BMC (92.7%). Elevated Lactate Dehydrogenase (LDH) levels (> 500), reflecting cell turnover and tumor burden, were found in 50.7% of children, with nearly equal proportions at KCMC (56.7%) and BMC (46.3%). Platelet counts varied notably: 45.8% of children had normal levels (150–450), 36.1% had low counts (< 150), suggesting possible bone marrow involvement, and 18.1% had elevated counts, more frequently at KCMC (32.3%) than BMC (7.3%). Anemia, indicated by low hemoglobin levels (< 10.5), was present in 61.1% of patients, with similar rates at KCMC (64.5%) and BMC (58.5%). Elevated uric acid levels (≥ 400) were found in 46.5% of cases, with a higher proportion at KCMC (51.6%) compared to BMC (42.5%) [ Table 3 ]. Table 3 Laboratory findings of Children with BL (N = 72) Characteristics Hospital KCMC n = 31(%) BMC n = 41 (%) Total N = 72 (%) ESR level < 10 1(3.2) 3(7.3) 4(5.6) ≥ 10 30(96.8) 38(92.7) 68(94.4) Lactate Dehydrogenase (n = 71) < 500 13(43.3) 22(53.7) 35(49.3) ≥ 500 17(56.7) 19(46.3) 36(50.7) Platelet (150–450) 13(41.9) 20(48.8) 33(45.8) ≥ 450 10(32.3) 3(7.3) 13(18.1) < 150 8(25.8) 18(43.9) 26(36.1) Hemoglobin 10.5–16 11(35.5) 17(41.5) 28(38.9) < (10.5) 20(64.5) 24(58.5) 44(61.1) Uric acid level (n = 71) < 400 15(48.4) 23(57.5) 38(53.5) ≥ 400 16(51.6) 17(42.5) 33(46.5) ESR- Erythrocyte Sedimentation Rate All 72 children receiving first-line therapy across both hospitals. At KCMC and BMC, 100% of the patients (31 and 41 respectively) underwent first-line treatment. Second-line treatment was administered to 26.4% ( 19 ) of the children. This included 22.6% ( 7 ) at KCMC and a higher proportion of 29.3% ( 12 ) at BMC [ Table 4 ]. Table 4 Treatment given (N = 72) Treatment Hospital KCMC n = 31 (%) BMC n = 41 (%) Total N = 72 (%) Received first line treatment (COM + Rituximab) 31 (100) 41(100) 72(100) Received second line (EMIC) 7(22.6) 12(29.3) 19(26.4) COM- Cyclophosphamide, Vincristine, and Methotrexate, EMIC- Etoposide, MESNA, Ifosfamide, Cytarabine Treatment outcomes in children with Burkitt lymphoma The treatment outcomes for children with Burkitt lymphoma varied significantly between facilities after the first line of treatment. The overall complete remission rate was 47.2%, with KCMC achieving a higher rate of 61.3% compared to BMC’s 36.6%. Conversely, BMC had a higher relapse rate at 19.5%, while KCMC’s rate was 6.5%. Treatment abandonment was also more frequent at BMC (22.0%) compared to KCMC (3.2%). Of the 19 children who either relapsed or failed the first line of treatment and subsequently received second-line therapy, 7 were from KCMC and 12 from BMC. At the end of the second-line treatment, 57.9% of these children had died, with a higher mortality rate at BMC (66.7%) compared to KCMC (42.9%). Complete remission was achieved in 10.5% of second-line cases, and another 10.5% experienced progressive disease [ Figure 2 ][ Figure 3 ]. Survival time summary for children with Burkitt lymphoma The mean survival time was 30.7 months (95%CI = 26.1–35.3). Following categories of the treatment facilities, for those treated at KCMC, the mean survival time of 37.1 months (95%CI = 32.0-42.2), higher compared to those received treatment at BMC where the mean survival time was 16.4 months (95%CI = 13.5–19.3) [ Table 5 ]. Table 5 Survival time summary for Children with Burkitt lymphoma (N = 72) Facility category No. observations Survival time (months) Mean SD [95% CI] KCMC 31 37.1 2.6 32.0-42.2 BMC 41 16.4 1.5 13.5–19.3 Total 72 30.7 2.3 26.1–35.3 BMC- Bugando Medical Centre, KCMC-Kilimanjaro Christian Medical Centre One year after treatment for Burkitt lymphoma, 43 children were alive, while 24 (33.3%) had died and 5 (6.9%) were lost to follow-up. Kaplan-Meier survival analysis indicated a 75% overall probability of surviving beyond 12 months. Children treated at KCMC had a notably higher one-year survival rate of over 90%, compared to below 65% at BMC. Survival rates varied significantly with diagnosis stage: high-risk patients had a 95% survival rate, CNS involvement was associated with a survival rate below 75%, and bone marrow involvement resulted in a survival rate under 40% (p = 0.008). Additionally, female patients had a higher one-year survival rate (above 80%) compared to males (75%) (p < 0.001) [ Figure 4 ][ Figure 5 ]. The predictors of mortality in childhood Burkitt lymphoma On evaluation of the predictors of mortality in children with BL, the Cox proportional hazards model identified several predictors of mortality in children with Burkitt lymphoma. Key predictors included age between 6–10 years (crude HR = 5.99, 95% CI: 2.16–16.60, p = 0.001), bone marrow involvement (crude HR = 19.20, 95% CI: 6.97–52.92, p < 0.001), and living in rural areas (crude HR = 3.01, 95% CI: 1.24–7.33, p = 0.015). Additionally, a distance of more than 100 km to the treatment facility (HR = 3.14, 95% CI: 1.22–8.08), CNS involvement (crude HR = 16.63, 95% CI: 2.67-103.45, p = 0.003), a family size greater than four (crude HR = 5.99, 95% CI: 2.00-17.96, p = 0.001), low hemoglobin levels (< 10.5) at diagnosis (crude HR = 15.19, 95% CI: 2.05–112.5, p = 0.008), and elevated uric acid and LDH levels (crude HR = 14.06, 95% CI: 3.30-60.01, p < 0.001; HR = 29.78, 95% CI: 4.02–220.80, p = 0.001) were significant. In the multivariate model, bone marrow involvement (AHR = 32.48, 95% CI: 2.21-477.83, p = 0.011) and CNS involvement remained significant predictors of mortality [ Table 6 ]. Table 6 The Cox proportional hazards regression for the predictors of mortality in childhood Burkitt lymphoma (N = 67) Variable n Died n (%) CHR (95% CI) P- value AHR (95% CI) P value Age < 5 years 34 5(14.7) 1 1 6–10 27 16(59.3) 5.99(2.16–16.60) 0.001 2.42(0.60–9.68) 0.212 11–18 6 3(50.0) 4.21(1.00-17.72) 0.05 2.69(0.45–16.12) 0.28 Sex of a child Male 46 18(39.1) 1 1 Female 21 6(28.6) 0.75(0.30–1.90) 0.545 0.36(0.05–2.78) 0.325 Location of resident Urban 33 7(21.2) 1 1 Rural 34 17(50.0) 3.01(1.24–7.33) 0.015 2.56(0.78–8.43) 0.122 Distance from home to facility (km) ≤ 100 29 6(20.7) 1 1 > 100 38 18(47.4) 3.14(1.22–8.08) 0.018 3.05(0.52–17.99) 0.219 Number of Children in the family < 5 30 4(13.3) 1 1 ≥ 5 37 20(54.0) 5.99(2.00-17.96) 0.001 0.40(0.08–2.10) 0.278 Bone marrow involvement No 48 6(12.5) 1 1 Yes 19 18(94.7) 19.20(6.97–52.92) < 0.001 32.48(2.21-477.83) 0.011 CNS present No 60 20(33.3) 1 1 Yes 7 4(57.1) 1.95(0.67–5.72) 0.222 34.00(1.74-662.99) 0.02 Time from diagnosis to treatment (weeks) < 2weeks 63 22(34.9) 1 1 ≥ 2weeks 4 2(50.0) 1.22(0.29–5.18) 0.791 1.21(0.15–10.07) 0.857 Hemoglobin level (10.5–16) 24 22(4.2) 1 1 < 10.5 43 23(53.5) 15.19(2.05–112.5) 0.008 0.30(0.01–18.56) 0.57 Uric acid level (n = 66) < 400 33 2(6.1) 1 1 ≥ 400 33 21(63.6) 14.06(3.30-60.01) < 0.001 0.39(0.04–4.10) 0.436 LDH (n = 66) < 500 31 1(3.2) 1 1 ≥ 500 35 23(65.7) 29.78(4.02–220.80) 0.001 34.98(1.07-1143.08) 0.05 CNS-Central nervous system, Km-kilometer, LDH - Lactate dehydrogenase, CHR- Crude Hazard Ratio, AHR- Adjusted Hazard Ratio, CI- Confidence Interval Discussion This study aimed to evaluate treatment outcomes, one-year survival rates, and predictors of mortality for childhood Burkitt lymphoma (BL) at KCMC and BMC, two tertiary hospitals in Tanzania. The findings revealed low complete remission rates, high mortality after the first line of treatment, and significant relapse rates, contrasting with higher remission rates and lower mortality observed in studies from Turkey and China, where complete remission after the first line of treatment was 72% and 87%, respectively, with lower death rates and relapse rates ( 25 ). Treatment abandonment in this study was 14%, which is lower compared to 85% in Nigeria and 1.6% in China. These differences highlight disparities in treatment outcomes between Tanzania and developed nations, potentially attributable to variations in chemotherapy protocols, financial resources, and follow-up practices ( 17 , 27 , 32 ). Thus improving our follow up plan, supportive care, while ensuring proper monitoring of advanced chemotherapy will help to mitigate abandonment of treatment, and improve outcomes in terms of high proportion of complete remission in LIC ( 27 , 32 ). In this study, outcomes for children who required second-line chemotherapy were notably poor, with only 10.5% achieving complete remission, 21% receiving palliative care, and 58% dying after treatment. This contrasts with a study from Egypt, where the complete remission rate after second-line chemotherapy was significantly higher at 24% ( 33 ). The disparity in remission rates may be attributed to more advanced disease stages and worse outcomes associated with disease progression compared to relapse. Future research should explore alternative treatment approaches, such as stem cell transplantation, which have shown promise in improving outcomes for patients with relapsed Burkitt lymphoma in high-income countries, as current intensive protocols still result in suboptimal outcomes ( 33 , 34 ). The survival rates of children with BL The study found a survival rate of approximately 75% one-year post-treatment between two tertiary centers, contrasting with a low figure of 60% in other Sub-Saharan countries ( 9 ). This difference can be attributed to high treatment abandonment, loss to follow-up, and poor monitoring, which may contribute to death due to treatment-related toxicity. The findings also differ from those of developed nations, where the 5-year overall survival rate was above 90% in the USA and Europe, compared to the high 1-year post-treatment survival rate in the study ( 35 , 36 ). According to these findings, the overall survival percentage for children with BL following treatment is quite high. We are making progress toward reaching the 90% survival rate that other high-income nations have attained, but we still have space for improvement. Difference in chemotherapy protocols together with ability to ensure proper monitoring of patients in treatments contribute to the difference in survival ( 17 ). Therefore, understanding the reasons for loss to follow-up and high treatment abandonment rates, enhancing supportive care, and adopting advanced chemotherapy protocols in low-income countries (LIC) could help improve survival rates ( 9 , 17 , 32 ). Predictors of Mortality of children with BL In this study, significant predictors of mortality included bone marrow and CNS involvement at diagnosis. These findings align with studies from both developing and developed countries, such as Egypt, Uganda, the USA, and China ( 31 , 37 , 38 ), where these factors were also associated with poor outcomes and mortality. Additionally, poor socioeconomic status and lack of insurance were noted as contributing factors in developed countries. In contrast, factors like female gender, urban residence, low hemoglobin levels, and high LDH levels ( 20 , 39 ), which were significant in studies from India and Kenya, did not show significant impact in this study. The association of bone marrow and CNS involvement with poor outcomes underscores the challenges in treating tumors in these sites and the high risk of relapse. Delays in diagnosis can exacerbate these issues. Enhancing awareness of early symptoms of childhood cancers, including Burkitt lymphoma, could facilitate earlier diagnosis and reduce the likelihood of advanced disease presentations, potentially improving outcomes and lowering mortality rates in low-income countries ( 40 , 41 ). Study limitations Since it was a retrospective study, data on factors such as poor nutritional status which did show strongly associated with mortality among patients with Burkitt Lymphoma in other literatures were poorly collected because of lack of parameters for malnutrition were not properly filled. Conclusion This study assesses treatment outcomes and survival rates for children with Burkitt lymphoma (BL) at two Tanzanian hospitals, revealing a 75% one-year survival rate, surpassing the WHO’s 2030 target. However, high treatment abandonment, relapse, and death rates, along with low complete remission rates, highlight significant challenges that could impact long-term survival. Key factors linked to poor prognosis include CNS and bone marrow involvement at diagnosis. The study calls for comprehensive interventions to enhance outcomes, such as; reducing diagnostic delays through increased public awareness, continuous healthcare provider education, and improved care access. Future research should explore adopting high-income countries' chemotherapy protocols, like high-dose methotrexate, with better monitoring for toxicity, and consider alternative treatments like stem cell transplantation for relapsed cases. Declarations Ethical clearance This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by The Kilimanjaro Clinical Research Ethics Committee, under reference number PG 101/2023. Written informed consent was obtained from parents/legal guardians before including children in the study. Consent to Participate declarations Not applicable Availability of data and materials On request, a copy of the data collected is available for review by the Editor-in-Chief of this journal. Competing interest Authors declare no competing interests. Funding This study received funding from the Kilimanjaro Clinical Research Institute. Acknowledgment The authors extend their gratitude to the pediatric teams at KCMC and BMC hospitals for their enthusiastic involvement in the manuscript preparation. They also acknowledge the significant contributions of the oncology teams at both centers and the Kilimanjaro Clinical Research Institute (KCRI) for their support in developing and finalizing this research. References Evens AM, Danilov A, Jagadeesh D, Sperling A, Kim S-H, Vaca R, et al. Burkitt lymphoma in the modern era: real-world outcomes and prognostication across 30 US cancer centers. Blood. 2021;137(3):374–86. Stefan C, Bray F, Ferlay J, Liu B, Parkin DM. Cancer of childhood in sub-Saharan Africa. Ecancermedicalscience. 2017;11. Kalisz K, Alessandrino F, Beck R, Smith D, Kikano E, Ramaiya NH, et al. An update on Burkitt lymphoma: a review of pathogenesis and multimodality imaging assessment of disease presentation, treatment response, and recurrence. Insights Imaging. 2019;10(1):56. Graham BS, Lynch DT. Burkitt Lymphoma. StatPearls. 2023. Molyneux EM, Rochford R, Griffin B, Newton R, Jackson G, Menon G, et al. Burkitt’s lymphoma. Lancet. 2012;379(9822):1234–44. NPCR, Incidence – SEER. U.S. Cancer Statistics Public Use Database Data Standards and Data Dictionary: 2001–2015. Hämmerl L, Colombet M, Rochford R, Ogwang DM, Parkin DM. The burden of Burkitt lymphoma in Africa. Infect Agent Cancer. 2019;14(1):17. Magrath I. Epidemiology: clues to the pathogenesis of Burkitt lymphoma. Br J Haematol. 2012;156(6):744–56. Bouda GC, Traoré F, Couitchere L, Raquin M-A, Guedenon KM, Pondy A et al. Advanced Burkitt Lymphoma in Sub-Saharan Africa Pediatric Units: Results of the Third Prospective Multicenter Study of the Groupe Franco-Africain d’Oncologie Pédiatrique. J Glob Oncol. 2019;(5):1–9. Simbiri KO, Biddle J, Kinyera T, Were PA, Tenge C, Kawira E et al. Burkitt lymphoma research in East Africa: Highlights from the 9thAfrican organization for research and training in cancer conference held in Durban, South Africa in 2013. Infect Agent Cancer. 2014;9(1):1–8. Carbone A. Classification of Tumors of the Hematopoietic and Lymphoid Tissues. Discovering Diseases—Defining Their Features Hemato. 2020;1(1):7–9. Musekwa E, Chapanduka ZC, Bassa F, Kruger M. An 8-year retrospective study of adult and paediatric Burkitt’s lymphoma at Tygerberg Hospital, South Africa. South Afr J Oncol. 2020;4. Wilson WH, Ph D. Burkitt’s Lymphoma. 2022;1111–22. Wilson WH, Ph D. Burkitt’s Lymphoma. 2022;1111–22. Roschewski M, Staudt LM, Wilson WH. Burkitt’s Lymphoma. Longo DL, editor. https://doi.org/101056/NEJMra2025746. 2022;387(12):1111–22. Ozuah NW, Lubega J, Allen CE, El-Mallawany NK. Five decades of low intensity and low survival: adapting intensified regimens to cure pediatric Burkitt lymphoma in Africa. Blood Adv. 2020;4(16):4007–19. Ozuah NW, Lubega J, Allen CE, El-mallawany NK. Five decades of low intensity and low survival: adapting intensi fi ed regimens to cure pediatric Burkitt lymphoma in Africa. 2020;4(16):1–3. Manji F, Chow E, Gerrie A, Chua N, Puckrin R, Stewart D, et al. Outcomes in Relapsed/Refractory Burkitt Lymphoma: A Multi-Centre Canadian Experience. Blood. 2021;138:2525–2525. Short NJ, Kantarjian HM, Ko H, Khoury JD, Ravandi F, Thomas DA, et al. Outcomes of adults with relapsed or refractory Burkitt and high-grade B-cell leukemia/lymphoma. Am J Hematol. 2017;92(6):E114–7. Buckle G, Maranda L, Skiles J, Ong’echa JM, Foley J, Epstein M, et al. Factors influencing survival among Kenyan children diagnosed with endemic Burkitt lymphoma between 2003 and 2011: A historical cohort study. Int J Cancer. 2016;139(6):1231–40. Noone A-M, Cronin KA, Altekruse SF, Howlader N, Lewis DR, Petkov VI, et al. Cancer Incidence and Survival Trends by Subtype Using Data from the Surveillance Epidemiology and End Results Program, 1992–2013. Cancer Epidemiol Biomarkers Prev. 2017;26(4):632–41. Opanga L, Mulaku MN, Opanga SA, Godman B, Kurdi A. Adverse effects of chemotherapy and their management in Pediatric patients with Non-Hodgkin’s Lymphoma in Kenya: A descriptive, situation analysis study. Expert Rev Anticancer Ther. 2019;19(5):423–30. Srinivasan S, Roy Moulik N, Kc A, Narula G, Sankaran H, Prasad M, et al. Increased toxicities in children with Burkitt lymphoma treated with rituximab: Experience from a tertiary cancer center in India. Pediatr Blood Cancer. 2020;67(11):e28682. Esau D. Denis Burkitt: A legacy of global health. J Med Biogr. 2019;27(1):4–8. Vural S, Genç DB, Kebudi R, Doğan Ö, Karaman S. Treatment results of modified bfm protocol in pediatric high-risk burkitt lymphoma. Turk J Pediatr. 2021;63(4):639. Chapman H, Ntemi PS, Kamanga J, Paschal J, Kashaigili HJ, Schroeder K. Abstract 33: Epidemiology, Diagnosis, and Outcomes of Pediatric Burkitt Lymphoma Patients Treated at Bugando Medical Centre in Mwanza, Tanzania. Cancer Epidemiol Biomarkers Prev. 2023;32(6Supplement):33. Zhang M, Jin L, Yang J, Duan YL, Huang S, Zhou CJ, et al. [Clinical and prognostic analysis of 186 children with Burkitt’s lymphoma]. Zhonghua Er Ke Za Zhi = Chin J Pediatr. 2018;56(8):605–10. Couitchere L, Raquin M, Guedenon KM. Advanced Burkitt Lymphoma in Sub-Saharan Africa Pediatric Units: Results of the Third Prospective Multicenter Study of the Groupe Franco-Africain d ’ Oncologie P ediatrique original reports abstract. 2023;1–9. Stanley CC, Westmoreland KD, Heimlich BJ, El-Mallawany NK, Wasswa P, Mtete I, et al. Outcomes for paediatric Burkitt lymphoma treated with anthracycline-based therapy in Malawi. Br J Haematol. 2016;173(5):705–12. Ngoma T, Adde M, Durosinmi M, Githang’a J, Aken’Ova Y, Kaijage J, et al. Treatment of Burkitt lymphoma in equatorial Africa using a simple three-drug combination followed by a salvage regimen for patients with persistent or recurrent disease. Br J Haematol. 2012;158(6):749–62. Khedr R, Maged E, Hafez H, Naguib E. ABCL-056: Outcome Predictors of Burkitt’s Lymphoma in Children and Adolescents in Egypt: A Single-Center Study. Clin Lymphoma Myeloma Leuk. 2020;20:S262. Su A, Ak A, Bu A, Ibrahim M, Ak A, Bu A. CC – BY Treatment outcome and abandon- ment rates in a retrospective cohort of children with Burkitt lymphoma in Kano. Nigeria. 2018;45(3):159–62. Semary SF, Abdel Rahman H, Elkinaai N, Zaky I, Nagy N, Salem S, et al. Prognostic Factors and Treatment Outcome of Relapsing and Refractory Pediatric Mature B-cell Non-Hodgkin Lymphoma, Children’s Cancer Hospital Egypt Experience. J Pediatr Hematol Oncol. 2023;45(6):e757. Jourdain A, Auperin A, Minard-Colin V, Aladjidi N, Zsiros J, Coze C, et al. Outcome of and prognostic factors for relapse in children and adolescents with mature B-cell lymphoma and leukemia treated in three consecutive prospective Lymphomes Malins B protocols. A Societe Francaise des Cancers de l’Enfant study. Haematologica. 2015;100(6):810–7. Aydin B, Akyuz C, Kalkan N, Kurucu N, Varan A, Yalcin B et al. FAB LMB 96 Regimen for Newly Diagnosed Burkitt Lymphoma in Children: Single-center Experience. J Pediatr Hematol Oncol. 2019;41(1). Mukhtar F, Boffetta P, Risch HA, Park JY, Bubu OM, Womack L, et al. Survival predictors of Burkitt’s lymphoma in children, adults and elderly in the United States during 2000–2013. Int J Cancer. 2017;140(7):1494–502. Alvarez E, Le T, Kahn J, Winestone L, Li Q, Keegan T. Comorbidities and socioeconomic status are predictors of survival in children and young adults with Burkitt lymphoma. Leuk Lymphoma. 2021;62(11):2804–7. Huang S, Jin L, Yang J, Duan Y-L, Zhang M, Zhou C-J, et al. Treatment outcome in children with central nervous system-positive Burkitt lymphoma using only intrathecal and systemic chemotherapy combined with rituximab. Chin Med J (Engl). 2021;134(11):1329–34. Patel A, Sharma MC, Mallick S, Patel M, Bakhshi S. Poor performance status, urban residence and female sex predict inferior survival in pediatric advanced stage mature B-NHL in an Indian tertiary care center. Pediatr Hematol Oncol. 2018;35(1):23–32. Woessmann W, Zimmermann M, Meinhardt A, Mueller S, Hauch H, Knörr F et al. Progressive or Relapsed Burkitt Lymphoma or Leukemia in Children and Adolescents after BFM-type First-line Therapy. Blood. 2020;blood.2019003591. Buckle GC, Collins JP, Sumba PO, Nakalema B, Omenah D, Stiffler K, et al. Factors influencing time to diagnosis and initiation of treatment of endemic Burkitt Lymphoma among children in Uganda and western Kenya: a cross-sectional survey. Infect Agent Cancer. 2013;8:36. Additional Declarations No competing interests reported. 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08:11:26","extension":"html","order_by":37,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":144032,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7810619/v1/91b4a7ce716371495f623441.html"},{"id":97124543,"identity":"19bfce74-4bde-48a1-a13a-b2e618bc3817","added_by":"auto","created_at":"2025-12-01 08:11:25","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":51584,"visible":true,"origin":"","legend":"\u003cp\u003eDemonstrating the patients enrolment flowchart\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7810619/v1/8832243477694f01181ab57c.png"},{"id":97124544,"identity":"3e30940e-ce5b-47ae-81f5-5bda0d5e6ab4","added_by":"auto","created_at":"2025-12-01 08:11:25","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":104457,"visible":true,"origin":"","legend":"\u003cp\u003eDemonstrating the treatment outcomes 1st line (N=72)\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7810619/v1/8d489f9205e6a9bd28f71e99.png"},{"id":97124542,"identity":"b0c5fd4a-cf2f-4f99-b01f-dd8e4c9ac455","added_by":"auto","created_at":"2025-12-01 08:11:25","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":51687,"visible":true,"origin":"","legend":"\u003cp\u003eDemonstrating the end of treatment outcomes 2nd Line (N=19)\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7810619/v1/cfe5fd51960ac2a83e25acf7.png"},{"id":97142392,"identity":"549e2eb2-79ba-4896-9f9d-ead9b07e2366","added_by":"auto","created_at":"2025-12-01 10:07:34","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":33134,"visible":true,"origin":"","legend":"\u003cp\u003eOne-year post-treatment survival rate among children with Burkitt lymphoma\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-7810619/v1/fc0c7a54dccbeccd2057a23f.png"},{"id":97124546,"identity":"0b2a9c23-ff49-49df-9e71-30f12e22160d","added_by":"auto","created_at":"2025-12-01 08:11:25","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":198617,"visible":true,"origin":"","legend":"\u003cp\u003eDemonstrating the Kaplan-Meir survival curves for children with BL\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-7810619/v1/b9687c47fd33d75614efd7a6.png"},{"id":97248405,"identity":"3c3d3ff5-5871-4ac4-8724-99d67cf8ace3","added_by":"auto","created_at":"2025-12-02 12:57:25","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1575689,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7810619/v1/67595317-8d0f-4ff8-8506-871680732d9d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eChildhood Burkit Lymphoma: The Treatment Outcomes, Survival Rates, and Predictors of Mortality at Two Tertiary Hospitals in Tanzania\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eBurkitt lymphoma (BL), is an aggressive B cell lymphoma that was first identified as a tumor in African children, affects people all over the world, with its incidence varies noticeably by region and even within regions. Clinically it can be classified into major three groups mainly endemic, sporadic and immunodeficiency-related (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). The endemic Burkitt lymphoma subtype is most common in equatorial Africa, particularly in areas with high malaria infection rates. It is linked to the Epstein-Barr virus (EBV) and frequently manifests as malignancies in the jaw or facial bones (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). The sporadic type is found all across the world, primarily affecting children and young people. It is less commonly associated with EBV, and tumors typically develop in the abdomen or other extra nodal locations. The immunodeficiency-associated Burkitt lymphoma subtype primarily affects people with weakened immune systems, such as those with HIV/AIDS or who have had organ transplants (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Each subtype of Burkitt lymphoma has a different clinical presentation and prognosis, including endemic, sporadic, and immunodeficiency-associated cases. Malaria and EBV are associated with the endemic type.\u003c/p\u003e\u003cp\u003eBurkitt Lymphoma (BL) is a rapidly growing mass with elevated uric acid and lactate dehydrogenase, affecting the abdomen, head, and neck. Symptoms include abdominal distension, nausea, vomiting, gastrointestinal bleeding, and pain. BL can cause periorbital swelling, jaw lesions, and genitourinary issues, especially in children. Diagnosis requires immunocolloidal studies, microscopic evaluation, and excision biopsy, with bone marrow aspiration and biopsy being crucial post-diagnosis. Treatment involves cytogenetics and immunohistochemistry, with cancerous B-cells showing IgM, positive markers, and positive CD10 and bcl-6 markers (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn 2018, global cancer statistics highlighted a significant burden, with an estimated 9.6\u0026nbsp;million cancer-related deaths and 18.1\u0026nbsp;million new cases. Among these, non-Hodgkin lymphoma, including Burkitt Lymphoma (BL), constituted approximately 2.8% of all cancer cases and 2.6% of cancer deaths, amounting to 500,000 cases and 250,000 deaths, respectively (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Over 400,000 children worldwide are diagnosed with cancer annually, with 80% in low- and middle-income countries. In the US, BL incidence declined, but Africa saw 3,900 new cases (\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). The incidence of BL in Africa varies significantly, with northern Uganda and Tanzania experiencing the highest rates, ranging from 2 to 15 cases per 100,000 children, while Kenya has an average annual rate of 0.61 per 100,000. Between 2000 and 2010, incidence patterns in northern Tanzania remained consistent (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eHIV and organ transplantation are linked to immunodeficiency-related variation, with distinctive morphology and chromosomal rearrangement involving the MYC oncogene unifying all patients with BL. The disease causes over half of all childhood malignancies in endemic areas and 40% to 50% of childhood non-Hodgkin's lymphomas in non-endemic areas (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe sporadic subtype of BL is common in the United States and Western Europe, with an annual incidence of three cases per million people in the general population, where it contribute to 30% of all pediatric lymphomas, with a peak prevalence around the age 10 (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). The precise global incidence of BL is unknown since collecting of these sorts of epidemiologic data is hampered by a lack of resources required for case identification and correct diagnosis in underdeveloped countries with the highest apparent incidence such as equatorial Africa (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Burkitt's lymphoma patients are managed as emergencies, with supportive care, electrolyte imbalances, and risk-adapted strategies, including short-term, dose-intensive chemotherapy, extended hospital stays, and strong blood product support (\u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eResearch indicates that children with intermediate and high-risk diseases need high-intensity cytotoxic chemotherapy to fully recover from BL. However, pediatric centers in Sub Saharan Africa struggle to provide supportive care for administering current gold standard regimens. In Blantyre, Malawi, a regimen with vincristine and cyclophosphamide with Methotrexate produced a poor 1-year EFS and high TRM (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Combination chemo-immunotherapy using agents like R-hyper-CVAD, CODOX-M/IVAC +/- R, dose-adjusted EPOCH-R, R-IVAC, R-GDP, R-ICE, and DHAP are salvage regimens for refractory or relapsed disease (\u003cspan additionalcitationids=\"CR17 CR18\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Although aggressive chemotherapy and supportive care can cure more than 90% of B-cell lymphomas diagnosed in affluent countries (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eChemotherapy is the most popular treatment for bone marrow leukemia (BL), with various medication combinations including vincristine, doxorubicin, prednisolone, and cyclophosphamide. Prednisolone is used to delay emesis and G-CSF is used to accelerate white blood cell synthesis. Rituximab is increasingly used to improve patient outcomes. However, chemotherapy has both short-term and long-term side effects, including alopecia, nausea, vomiting, bone marrow suppression, and a decline in quality of life. Monitoring these side effects is crucial to reduce morbidity and death (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eModern treatment for BL treatment is more effective in high-income countries due to early detection programs, multimodal therapies, and diagnostics. In Turkey, 72% of children had complete remissions, while 22% died in hospital (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). In East Africa, 78% of children with eBL completed six rounds of chemotherapy, with 31% surviving without events, 16% relapsing, and 31% lost to follow-up (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eBurkitt lymphoma (BL) in children varies across countries, with less than 50% in certain African LMICs and over 90% in high-income nations. Factors such as age, stage of diagnosis, socioeconomic situation, lack of resources, and comorbidities like hunger hinder survival in underdeveloped nations (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). In the US, a 5-year relative survival rate of 90.4% was reported for 797 pediatric BL patients under 15, while in Sub-Saharan Africa, a 60% overall survival rate was observed. In Malawi, 73 children under 18 were diagnosed with BL, with 66% being male and 2 testing positive for the virus. In East Africa, a 45% overall one-year survival rate was reported for 428 children with endemic BL. In Tanzania, a 50.2% overall survival rate was observed among 109 children receiving treatment (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Burkitt lymphoma (BL) survival rates vary, with less than 50% in certain African LMICs and over 90% in high-income nations. Factors like age, stage of diagnosis, socioeconomic situation, lack of resources, and comorbidities like hunger hinder survival in underdeveloped nations. In the US, a 5-year relative survival rate of 90.4% was reported, while in Sub-Saharan Africa, a 1-year overall survival rate of 60% was reported. Long-term survival rates in Africa are much lower (\u003cspan additionalcitationids=\"CR28 CR29\" citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). A study in Egypt observed factors like bone marrow and CNS involvement linked to worse outcomes in children with Burkitt lymphoma (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). A Kenyan research study saw that low hemoglobin and high LDH were linked to increased death risk. Anemia and malarial infection had a mortality rate of 1.10\u0026ndash;11.44, which was 3.55 times lower in anemic children with malaria. EBV load was not related to survival or different depending on tumor stage (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIt is noted that, poor outcomes in children with Burkitt lymphoma (BL) in developing countries are attributed to factors such as; lack of chemotherapy supplies, abandonment, toxicities, and delays in diagnosis. Despite the ongoing research to depict the most effective regimens and biomarkers, the consensus on the best regimen and biomarkers remains unresolved. This study aims at delineating the treatment outcomes, one-year post-treatment survival rate and predictors of mortality in childhood Burkitt lymphoma at two tertiary hospitals in Tanzania.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003eThis retrospective cohort study was conducted at Kilimanjaro Christian Medical Center (KCMC) and Bugando Medical Center (BMC) in Tanzania, examining records of children treated for Burkitt lymphoma (BL) between January 1, 2020, and December 31, 2022. The research, which spanned from July 2023 to July 2024, involved analyzing data from the oncology and histopathology departments at both centers. The study aimed to assess BL treatment outcomes and involved the formulation of the proposal, data collection, analysis, and report writing within the one-year timeframe. The study focused on children under 18 with confirmed Burkitt lymphoma (BL) who began treatment at the pediatric oncology departments of KCMC and BMC between January 1, 2020, and December 31, 2022. Participants were followed for one year, up to December 31, 2023, to assess survival rates. The study included only those with histologically confirmed BL who received treatment within the specified period and excluded patients with unconfirmed BL or those who presented with recurrence.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eData collection and analysis methods\u003c/h2\u003e\u003cp\u003eData were collected using a comprehensive extraction sheet covering sociodemographic information, clinical characteristics, laboratory findings at diagnosis, and one-year treatment outcomes. Patient file numbers that met the inclusion criteria were retrieved from the oncology registry system and used to access both electronic and physical medical records, excluding those with unconfirmed histological diagnoses of Burkitt lymphoma. The study evaluated dependent variables including treatment outcomes such as complete remission, relapse, progressive disease, treatment abandonment, and death, as well as one-year post-treatment survival rates categorized as alive, dead, or lost to follow-up. Survival time was measured continuously in months and summarized with mean and confidence intervals. Independent variables assessed included demographic factors (age, sex, residence location, distance to treatment facility, family size, insurance coverage), clinical characteristics (tumor site, risk classification, CNS and bone marrow involvement), treatment details (treatment facility, time from diagnosis to treatment start), and laboratory findings at diagnosis (hemoglobin, uric acid, LDH, platelet count, ESR).\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eData analysis methods\u003c/h3\u003e\n\u003cp\u003eStatistical analyses were performed using Stata 18. Descriptive statistics were employed to summarize the study population's background characteristics. Numerical variables, such as age, were described using means and standard deviations, while categorical variables, including sex, location of residence, health insurance status, treatment facility, tumor site, risk classification, CNS involvement, and bone marrow involvement, were summarized with frequencies and percentages.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThere were 138 patients with diagnosis of BL in total at KCMC and BMC ,66 patients were excluded from analysis due to following reasons diagnosis changed to other cancers, missing files, death before finishing treatments \u003cb\u003e[\u003c/b\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e].\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eIn this study of 72 children with Burkitt Lymphoma (BL), the majority were boys (70.8%), with similar proportions at KCMC (71.0%) and BMC (70.7%). Most children were under 5 years old (51.8% overall; KCMC 58.1%, BMC 46.3%). A significant portion resided in rural areas (52.8%; KCMC 51.6%, BMC 53.7%). Larger families, with more than four children, were more common overall (59.3%), particularly at BMC (70.7%), whereas smaller families were more frequent at KCMC (58.1%). Most children lacked health insurance (73.6%), a trend consistent at both KCMC (74.2%) and BMC (73.2%) \u003cb\u003e[\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e].\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBackground characteristics of children with (N\u0026thinsp;=\u0026thinsp;72)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eHospital\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristics\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eKCMC\u003c/b\u003e\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;31(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eBMC\u003c/b\u003e\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;41 (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;72 (%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18(58.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19(46.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e37(51.84)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6\u0026ndash;10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9(29.)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18(43.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e27(37.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e11\u0026ndash;18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4(12.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4(9.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8(11.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSex of a child\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15(71.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19(70.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e51(70.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e16(29.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22(29.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21(29.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLocation of resident\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUrban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15(48.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19(46.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e34(47.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRural\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e16(51.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22(53.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e38(52.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNumber of children in the family\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026le;\u0026thinsp;4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18(58.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12(29.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e30(41.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13(41.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29(70.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e42(59.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHealth Insurance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23(74.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30(73.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e53(73.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8(25.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11(26.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e19(26.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe mandibular region was the most common tumor site among the children with Burkitt Lymphoma (BL), affecting 47.2% of cases overall, with a higher prevalence at KCMC (67.7%) compared to BMC (31.7%). Abdominal masses were more common at BMC (58.5%) than at KCMC (29.0%). Other tumor sites, such as the retro-orbital region and testicular area, were less frequent. High-risk stage at diagnosis was noted in 63.9% of cases, with a higher proportion at KCMC (71.0%) compared to BMC (58.5%). CNS involvement was more common at KCMC (16.1%) and bone marrow involvement was higher at BMC (36.6%). Most children began treatment within two weeks of diagnosis (94.4%), with 100% at BMC and 87.1% at KCMC starting within this timeframe \u003cb\u003e[\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cb\u003e].\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eClinical-pathological characteristics of Children with BL (N\u0026thinsp;=\u0026thinsp;72)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eHospital\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristics\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eKCMC\u003c/b\u003e\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;31(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eBMC\u003c/b\u003e\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;41(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;72 (%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSite of the tumor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMandibular\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21(67.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13(31.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e34(47.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRetro-orbital\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1(3.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3(7.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4(5.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAbdominal mass\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9(29.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24(58.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e33(45.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTesticular\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0(0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1(2.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1(1.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBL stage at diagnosis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigh risk (Group B)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22(71.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24(58.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e46(63.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCNS present (Group C)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5(16.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2(4.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7(9.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBone marrow (Group D)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4(12.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15(36.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e19(26.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTime from diagnosis to treatment (weeks)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026le;\u0026thinsp;2 weeks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e27(87.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e41(100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e68(94.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;2 weeks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4(12.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0(0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4(5.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003eBL-Burkitt Lymphoma CNS-Central Nervous System\u003c/h3\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eLaboratory findings of children with Burkitt lymphoma\u003c/h2\u003e\u003cp\u003eLaboratory evaluations revealed that an elevated Erythrocyte Sedimentation Rate (ESR) (\u0026gt;\u0026thinsp;10), indicating an inflammatory response, was observed in 94.4% of patients, with similar high rates at KCMC (96.8%) and BMC (92.7%). Elevated Lactate Dehydrogenase (LDH) levels (\u0026gt;\u0026thinsp;500), reflecting cell turnover and tumor burden, were found in 50.7% of children, with nearly equal proportions at KCMC (56.7%) and BMC (46.3%). Platelet counts varied notably: 45.8% of children had normal levels (150\u0026ndash;450), 36.1% had low counts (\u0026lt;\u0026thinsp;150), suggesting possible bone marrow involvement, and 18.1% had elevated counts, more frequently at KCMC (32.3%) than BMC (7.3%). Anemia, indicated by low hemoglobin levels (\u0026lt;\u0026thinsp;10.5), was present in 61.1% of patients, with similar rates at KCMC (64.5%) and BMC (58.5%). Elevated uric acid levels (\u0026ge;\u0026thinsp;400) were found in 46.5% of cases, with a higher proportion at KCMC (51.6%) compared to BMC (42.5%) \u003cb\u003e[\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003cb\u003e].\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eLaboratory findings of Children with BL (N\u0026thinsp;=\u0026thinsp;72)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eCharacteristics\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eHospital\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eKCMC\u003c/b\u003e\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;31(%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eBMC\u003c/b\u003e\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;41 (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;72 (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eESR level\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1(3.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3(7.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4(5.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e30(96.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e38(92.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e68(94.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLactate Dehydrogenase (n\u0026thinsp;=\u0026thinsp;71)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;500\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e13(43.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e22(53.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e35(49.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;500\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e17(56.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e19(46.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e36(50.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePlatelet\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e(150\u0026ndash;450)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e13(41.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e20(48.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e33(45.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;450\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e10(32.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3(7.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e13(18.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;150\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8(25.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e18(43.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e26(36.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHemoglobin\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10.5\u0026ndash;16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e11(35.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e17(41.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e28(38.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt; (10.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e20(64.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e24(58.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e44(61.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUric acid level (n\u0026thinsp;=\u0026thinsp;71)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;400\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e15(48.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e23(57.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e38(53.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;400\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e16(51.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e17(42.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e33(46.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eESR- Erythrocyte Sedimentation Rate\u003c/h2\u003e\u003cp\u003eAll 72 children receiving first-line therapy across both hospitals. At KCMC and BMC, 100% of the patients (31 and 41 respectively) underwent first-line treatment. Second-line treatment was administered to 26.4% (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) of the children. This included 22.6% (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) at KCMC and a higher proportion of 29.3% (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) at BMC \u003cb\u003e[\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e\u003cb\u003e].\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eTreatment given (N\u0026thinsp;=\u0026thinsp;72)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eTreatment\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eHospital\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eKCMC\u003c/b\u003e\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;31 (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eBMC\u003c/b\u003e\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;41 (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;72 (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eReceived first line treatment (COM\u0026thinsp;+\u0026thinsp;Rituximab)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e31 (100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e41(100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e72(100)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eReceived second line (EMIC)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7(22.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12(29.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e19(26.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eCOM- Cyclophosphamide, Vincristine, and Methotrexate, EMIC- Etoposide, MESNA, Ifosfamide, Cytarabine\u003c/h3\u003e\n\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003eTreatment outcomes in children with Burkitt lymphoma\u003c/h2\u003e\u003cp\u003eThe treatment outcomes for children with Burkitt lymphoma varied significantly between facilities after the first line of treatment. The overall complete remission rate was 47.2%, with KCMC achieving a higher rate of 61.3% compared to BMC\u0026rsquo;s 36.6%. Conversely, BMC had a higher relapse rate at 19.5%, while KCMC\u0026rsquo;s rate was 6.5%. Treatment abandonment was also more frequent at BMC (22.0%) compared to KCMC (3.2%). Of the 19 children who either relapsed or failed the first line of treatment and subsequently received second-line therapy, 7 were from KCMC and 12 from BMC. At the end of the second-line treatment, 57.9% of these children had died, with a higher mortality rate at BMC (66.7%) compared to KCMC (42.9%). Complete remission was achieved in 10.5% of second-line cases, and another 10.5% experienced progressive disease \u003cb\u003e[\u003c/b\u003eFigure \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cb\u003e][\u003c/b\u003eFigure \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003cb\u003e].\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eSurvival time summary for children with Burkitt lymphoma\u003c/h2\u003e\u003cp\u003eThe mean survival time was 30.7 months (95%CI\u0026thinsp;=\u0026thinsp;26.1\u0026ndash;35.3). Following categories of the treatment facilities, for those treated at KCMC, the mean survival time of 37.1 months (95%CI\u0026thinsp;=\u0026thinsp;32.0-42.2), higher compared to those received treatment at BMC where the mean survival time was 16.4 months (95%CI\u0026thinsp;=\u0026thinsp;13.5\u0026ndash;19.3) \u003cb\u003e[\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e\u003cb\u003e].\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSurvival time summary for Children with Burkitt lymphoma (N\u0026thinsp;=\u0026thinsp;72)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eFacility category\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eNo. observations\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u003cp\u003eSurvival time (months)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eMean\u003c/b\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eSD\u003c/b\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e[95% CI]\u003c/b\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKCMC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e37.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e32.0-42.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e16.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e13.5\u0026ndash;19.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e30.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e26.1\u0026ndash;35.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eBMC- Bugando Medical Centre, KCMC-Kilimanjaro Christian Medical Centre\u003c/h2\u003e\u003cp\u003eOne year after treatment for Burkitt lymphoma, 43 children were alive, while 24 (33.3%) had died and 5 (6.9%) were lost to follow-up. Kaplan-Meier survival analysis indicated a 75% overall probability of surviving beyond 12 months. Children treated at KCMC had a notably higher one-year survival rate of over 90%, compared to below 65% at BMC. Survival rates varied significantly with diagnosis stage: high-risk patients had a 95% survival rate, CNS involvement was associated with a survival rate below 75%, and bone marrow involvement resulted in a survival rate under 40% (p\u0026thinsp;=\u0026thinsp;0.008). Additionally, female patients had a higher one-year survival rate (above 80%) compared to males (75%) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) \u003cb\u003e[\u003c/b\u003eFigure \u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e\u003cb\u003e][\u003c/b\u003eFigure \u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e\u003cb\u003e].\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eThe predictors of mortality in childhood Burkitt lymphoma\u003c/h2\u003e\u003cp\u003eOn evaluation of the predictors of mortality in children with BL, the Cox proportional hazards model identified several predictors of mortality in children with Burkitt lymphoma. Key predictors included age between 6\u0026ndash;10 years (crude HR\u0026thinsp;=\u0026thinsp;5.99, 95% CI: 2.16\u0026ndash;16.60, p\u0026thinsp;=\u0026thinsp;0.001), bone marrow involvement (crude HR\u0026thinsp;=\u0026thinsp;19.20, 95% CI: 6.97\u0026ndash;52.92, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and living in rural areas (crude HR\u0026thinsp;=\u0026thinsp;3.01, 95% CI: 1.24\u0026ndash;7.33, p\u0026thinsp;=\u0026thinsp;0.015). Additionally, a distance of more than 100 km to the treatment facility (HR\u0026thinsp;=\u0026thinsp;3.14, 95% CI: 1.22\u0026ndash;8.08), CNS involvement (crude HR\u0026thinsp;=\u0026thinsp;16.63, 95% CI: 2.67-103.45, p\u0026thinsp;=\u0026thinsp;0.003), a family size greater than four (crude HR\u0026thinsp;=\u0026thinsp;5.99, 95% CI: 2.00-17.96, p\u0026thinsp;=\u0026thinsp;0.001), low hemoglobin levels (\u0026lt;\u0026thinsp;10.5) at diagnosis (crude HR\u0026thinsp;=\u0026thinsp;15.19, 95% CI: 2.05\u0026ndash;112.5, p\u0026thinsp;=\u0026thinsp;0.008), and elevated uric acid and LDH levels (crude HR\u0026thinsp;=\u0026thinsp;14.06, 95% CI: 3.30-60.01, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001; HR\u0026thinsp;=\u0026thinsp;29.78, 95% CI: 4.02\u0026ndash;220.80, p\u0026thinsp;=\u0026thinsp;0.001) were significant. In the multivariate model, bone marrow involvement (AHR\u0026thinsp;=\u0026thinsp;32.48, 95% CI: 2.21-477.83, p\u0026thinsp;=\u0026thinsp;0.011) and CNS involvement remained significant predictors of mortality \u003cb\u003e[\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e\u003cb\u003e].\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThe Cox proportional hazards regression for the predictors of mortality in childhood Burkitt lymphoma (N\u0026thinsp;=\u0026thinsp;67)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003en\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDied\u003c/p\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eCHR (95% CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP- value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eAHR (95% CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;5 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5(14.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6\u0026ndash;10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e16(59.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.99(2.16\u0026ndash;16.60)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.42(0.60\u0026ndash;9.68)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.212\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e11\u0026ndash;18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3(50.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.21(1.00-17.72)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.69(0.45\u0026ndash;16.12)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.28\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eSex of a child\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e18(39.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6(28.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.75(0.30\u0026ndash;1.90)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.545\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.36(0.05\u0026ndash;2.78)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.325\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eLocation of resident\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUrban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7(21.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRural\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e17(50.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.01(1.24\u0026ndash;7.33)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.015\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.56(0.78\u0026ndash;8.43)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.122\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eDistance from home\u003c/p\u003e\u003cp\u003eto facility (km)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026le;\u0026thinsp;100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6(20.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e18(47.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.14(1.22\u0026ndash;8.08)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.018\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.05(0.52\u0026ndash;17.99)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.219\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eNumber of Children\u003c/p\u003e\u003cp\u003ein the family\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4(13.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e20(54.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.99(2.00-17.96)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.40(0.08\u0026ndash;2.10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.278\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eBone marrow\u003c/p\u003e\u003cp\u003einvolvement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6(12.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e18(94.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e19.20(6.97\u0026ndash;52.92)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e32.48(2.21-477.83)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e0.011\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCNS present\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e20(33.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4(57.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.95(0.67\u0026ndash;5.72)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.222\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e34.00(1.74-662.99)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e0.02\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003eTime from\u003c/p\u003e\u003cp\u003ediagnosis to treatment (weeks)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;2weeks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e22(34.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;2weeks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2(50.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.22(0.29\u0026ndash;5.18)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.791\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.21(0.15\u0026ndash;10.07)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.857\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eHemoglobin level\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e(10.5\u0026ndash;16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e22(4.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;10.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e23(53.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15.19(2.05\u0026ndash;112.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.008\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.30(0.01\u0026ndash;18.56)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.57\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eUric acid level (n\u0026thinsp;=\u0026thinsp;66)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;400\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2(6.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;400\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e21(63.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14.06(3.30-60.01)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.39(0.04\u0026ndash;4.10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.436\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLDH (n\u0026thinsp;=\u0026thinsp;66)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;500\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1(3.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;500\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e23(65.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e29.78(4.02\u0026ndash;220.80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e34.98(1.07-1143.08)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.05\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eCNS-Central nervous system, Km-kilometer, LDH - Lactate dehydrogenase, CHR- Crude Hazard Ratio, AHR- Adjusted Hazard Ratio, CI- Confidence Interval\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study aimed to evaluate treatment outcomes, one-year survival rates, and predictors of mortality for childhood Burkitt lymphoma (BL) at KCMC and BMC, two tertiary hospitals in Tanzania. The findings revealed low complete remission rates, high mortality after the first line of treatment, and significant relapse rates, contrasting with higher remission rates and lower mortality observed in studies from Turkey and China, where complete remission after the first line of treatment was 72% and 87%, respectively, with lower death rates and relapse rates (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). Treatment abandonment in this study was 14%, which is lower compared to 85% in Nigeria and 1.6% in China. These differences highlight disparities in treatment outcomes between Tanzania and developed nations, potentially attributable to variations in chemotherapy protocols, financial resources, and follow-up practices (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). Thus improving our follow up plan, supportive care, while ensuring proper monitoring of advanced chemotherapy will help to mitigate abandonment of treatment, and improve outcomes in terms of high proportion of complete remission in LIC (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). In this study, outcomes for children who required second-line chemotherapy were notably poor, with only 10.5% achieving complete remission, 21% receiving palliative care, and 58% dying after treatment. This contrasts with a study from Egypt, where the complete remission rate after second-line chemotherapy was significantly higher at 24% (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). The disparity in remission rates may be attributed to more advanced disease stages and worse outcomes associated with disease progression compared to relapse. Future research should explore alternative treatment approaches, such as stem cell transplantation, which have shown promise in improving outcomes for patients with relapsed Burkitt lymphoma in high-income countries, as current intensive protocols still result in suboptimal outcomes (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e).\u003c/p\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eThe survival rates of children with BL\u003c/h2\u003e\u003cp\u003eThe study found a survival rate of approximately 75% one-year post-treatment between two tertiary centers, contrasting with a low figure of 60% in other Sub-Saharan countries (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). This difference can be attributed to high treatment abandonment, loss to follow-up, and poor monitoring, which may contribute to death due to treatment-related toxicity. The findings also differ from those of developed nations, where the 5-year overall survival rate was above 90% in the USA and Europe, compared to the high 1-year post-treatment survival rate in the study (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAccording to these findings, the overall survival percentage for children with BL following treatment is quite high. We are making progress toward reaching the 90% survival rate that other high-income nations have attained, but we still have space for improvement. Difference in chemotherapy protocols together with ability to ensure proper monitoring of patients in treatments contribute to the difference in survival (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Therefore, understanding the reasons for loss to follow-up and high treatment abandonment rates, enhancing supportive care, and adopting advanced chemotherapy protocols in low-income countries (LIC) could help improve survival rates (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003ePredictors of Mortality of children with BL\u003c/h2\u003e\u003cp\u003eIn this study, significant predictors of mortality included bone marrow and CNS involvement at diagnosis. These findings align with studies from both developing and developed countries, such as Egypt, Uganda, the USA, and China (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e), where these factors were also associated with poor outcomes and mortality. Additionally, poor socioeconomic status and lack of insurance were noted as contributing factors in developed countries. In contrast, factors like female gender, urban residence, low hemoglobin levels, and high LDH levels (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e), which were significant in studies from India and Kenya, did not show significant impact in this study. The association of bone marrow and CNS involvement with poor outcomes underscores the challenges in treating tumors in these sites and the high risk of relapse. Delays in diagnosis can exacerbate these issues. Enhancing awareness of early symptoms of childhood cancers, including Burkitt lymphoma, could facilitate earlier diagnosis and reduce the likelihood of advanced disease presentations, potentially improving outcomes and lowering mortality rates in low-income countries (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003eStudy limitations\u003c/h2\u003e\u003cp\u003eSince it was a retrospective study, data on factors such as poor nutritional status which did show strongly associated with mortality among patients with Burkitt Lymphoma in other literatures were poorly collected because of lack of parameters for malnutrition were not properly filled.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study assesses treatment outcomes and survival rates for children with Burkitt lymphoma (BL) at two Tanzanian hospitals, revealing a 75% one-year survival rate, surpassing the WHO\u0026rsquo;s 2030 target. However, high treatment abandonment, relapse, and death rates, along with low complete remission rates, highlight significant challenges that could impact long-term survival. Key factors linked to poor prognosis include CNS and bone marrow involvement at diagnosis. The study calls for comprehensive interventions to enhance outcomes, such as; reducing diagnostic delays through increased public awareness, continuous healthcare provider education, and improved care access. Future research should explore adopting high-income countries' chemotherapy protocols, like high-dose methotrexate, with better monitoring for toxicity, and consider alternative treatments like stem cell transplantation for relapsed cases.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical clearance\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by The Kilimanjaro Clinical Research Ethics Committee, under reference number PG 101/2023. Written informed consent was obtained from parents/legal guardians before including children in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate declarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOn request, a copy of the data collected is available for review by the Editor-in-Chief of this journal.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study received funding from the Kilimanjaro Clinical Research Institute.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgment\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors extend their gratitude to the pediatric teams at KCMC and BMC hospitals for their enthusiastic involvement in the manuscript preparation. They also acknowledge the significant contributions of the oncology teams at both centers and the Kilimanjaro Clinical Research Institute (KCRI) for their support in developing and finalizing this research.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eEvens AM, Danilov A, Jagadeesh D, Sperling A, Kim S-H, Vaca R, et al. Burkitt lymphoma in the modern era: real-world outcomes and prognostication across 30 US cancer centers. Blood. 2021;137(3):374\u0026ndash;86.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eStefan C, Bray F, Ferlay J, Liu B, Parkin DM. Cancer of childhood in sub-Saharan Africa. Ecancermedicalscience. 2017;11.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKalisz K, Alessandrino F, Beck R, Smith D, Kikano E, Ramaiya NH, et al. An update on Burkitt lymphoma: a review of pathogenesis and multimodality imaging assessment of disease presentation, treatment response, and recurrence. Insights Imaging. 2019;10(1):56.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGraham BS, Lynch DT. Burkitt Lymphoma. StatPearls. 2023.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMolyneux EM, Rochford R, Griffin B, Newton R, Jackson G, Menon G, et al. Burkitt\u0026rsquo;s lymphoma. Lancet. 2012;379(9822):1234\u0026ndash;44.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNPCR, Incidence \u0026ndash; SEER. U.S. Cancer Statistics Public Use Database Data Standards and Data Dictionary: 2001\u0026ndash;2015.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eH\u0026auml;mmerl L, Colombet M, Rochford R, Ogwang DM, Parkin DM. The burden of Burkitt lymphoma in Africa. Infect Agent Cancer. 2019;14(1):17.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMagrath I. Epidemiology: clues to the pathogenesis of Burkitt lymphoma. Br J Haematol. 2012;156(6):744\u0026ndash;56.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBouda GC, Traor\u0026eacute; F, Couitchere L, Raquin M-A, Guedenon KM, Pondy A et al. Advanced Burkitt Lymphoma in Sub-Saharan Africa Pediatric Units: Results of the Third Prospective Multicenter Study of the Groupe Franco-Africain d\u0026rsquo;Oncologie P\u0026eacute;diatrique. J Glob Oncol. 2019;(5):1\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSimbiri KO, Biddle J, Kinyera T, Were PA, Tenge C, Kawira E et al. Burkitt lymphoma research in East Africa: Highlights from the 9thAfrican organization for research and training in cancer conference held in Durban, South Africa in 2013. Infect Agent Cancer. 2014;9(1):1\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCarbone A. Classification of Tumors of the Hematopoietic and Lymphoid Tissues. Discovering Diseases\u0026mdash;Defining Their Features Hemato. 2020;1(1):7\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMusekwa E, Chapanduka ZC, Bassa F, Kruger M. An 8-year retrospective study of adult and paediatric Burkitt\u0026rsquo;s lymphoma at Tygerberg Hospital, South Africa. South Afr J Oncol. 2020;4.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWilson WH, Ph D. Burkitt\u0026rsquo;s Lymphoma. 2022;1111\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWilson WH, Ph D. Burkitt\u0026rsquo;s Lymphoma. 2022;1111\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRoschewski M, Staudt LM, Wilson WH. Burkitt\u0026rsquo;s Lymphoma. Longo DL, editor. https://doi.org/101056/NEJMra2025746. 2022;387(12):1111\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOzuah NW, Lubega J, Allen CE, El-Mallawany NK. Five decades of low intensity and low survival: adapting intensified regimens to cure pediatric Burkitt lymphoma in Africa. Blood Adv. 2020;4(16):4007\u0026ndash;19.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOzuah NW, Lubega J, Allen CE, El-mallawany NK. Five decades of low intensity and low survival: adapting intensi fi ed regimens to cure pediatric Burkitt lymphoma in Africa. 2020;4(16):1\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eManji F, Chow E, Gerrie A, Chua N, Puckrin R, Stewart D, et al. Outcomes in Relapsed/Refractory Burkitt Lymphoma: A Multi-Centre Canadian Experience. Blood. 2021;138:2525\u0026ndash;2525.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShort NJ, Kantarjian HM, Ko H, Khoury JD, Ravandi F, Thomas DA, et al. Outcomes of adults with relapsed or refractory Burkitt and high-grade B-cell leukemia/lymphoma. Am J Hematol. 2017;92(6):E114\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBuckle G, Maranda L, Skiles J, Ong\u0026rsquo;echa JM, Foley J, Epstein M, et al. Factors influencing survival among Kenyan children diagnosed with endemic Burkitt lymphoma between 2003 and 2011: A historical cohort study. Int J Cancer. 2016;139(6):1231\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNoone A-M, Cronin KA, Altekruse SF, Howlader N, Lewis DR, Petkov VI, et al. Cancer Incidence and Survival Trends by Subtype Using Data from the Surveillance Epidemiology and End Results Program, 1992\u0026ndash;2013. Cancer Epidemiol Biomarkers Prev. 2017;26(4):632\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOpanga L, Mulaku MN, Opanga SA, Godman B, Kurdi A. Adverse effects of chemotherapy and their management in Pediatric patients with Non-Hodgkin\u0026rsquo;s Lymphoma in Kenya: A descriptive, situation analysis study. Expert Rev Anticancer Ther. 2019;19(5):423\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSrinivasan S, Roy Moulik N, Kc A, Narula G, Sankaran H, Prasad M, et al. Increased toxicities in children with Burkitt lymphoma treated with rituximab: Experience from a tertiary cancer center in India. Pediatr Blood Cancer. 2020;67(11):e28682.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEsau D. Denis Burkitt: A legacy of global health. J Med Biogr. 2019;27(1):4\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVural S, Gen\u0026ccedil; DB, Kebudi R, Doğan \u0026Ouml;, Karaman S. Treatment results of modified bfm protocol in pediatric high-risk burkitt lymphoma. Turk J Pediatr. 2021;63(4):639.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChapman H, Ntemi PS, Kamanga J, Paschal J, Kashaigili HJ, Schroeder K. Abstract 33: Epidemiology, Diagnosis, and Outcomes of Pediatric Burkitt Lymphoma Patients Treated at Bugando Medical Centre in Mwanza, Tanzania. Cancer Epidemiol Biomarkers Prev. 2023;32(6Supplement):33.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhang M, Jin L, Yang J, Duan YL, Huang S, Zhou CJ, et al. [Clinical and prognostic analysis of 186 children with Burkitt\u0026rsquo;s lymphoma]. Zhonghua Er Ke Za Zhi = Chin J Pediatr. 2018;56(8):605\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCouitchere L, Raquin M, Guedenon KM. Advanced Burkitt Lymphoma in Sub-Saharan Africa Pediatric Units: Results of the Third Prospective Multicenter Study of the Groupe Franco-Africain d \u0026rsquo; Oncologie P ediatrique original reports abstract. 2023;1\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eStanley CC, Westmoreland KD, Heimlich BJ, El-Mallawany NK, Wasswa P, Mtete I, et al. Outcomes for paediatric Burkitt lymphoma treated with anthracycline-based therapy in Malawi. Br J Haematol. 2016;173(5):705\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNgoma T, Adde M, Durosinmi M, Githang\u0026rsquo;a J, Aken\u0026rsquo;Ova Y, Kaijage J, et al. Treatment of Burkitt lymphoma in equatorial Africa using a simple three-drug combination followed by a salvage regimen for patients with persistent or recurrent disease. Br J Haematol. 2012;158(6):749\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKhedr R, Maged E, Hafez H, Naguib E. ABCL-056: Outcome Predictors of Burkitt\u0026rsquo;s Lymphoma in Children and Adolescents in Egypt: A Single-Center Study. Clin Lymphoma Myeloma Leuk. 2020;20:S262.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSu A, Ak A, Bu A, Ibrahim M, Ak A, Bu A. CC \u0026ndash; BY Treatment outcome and abandon- ment rates in a retrospective cohort of children with Burkitt lymphoma in Kano. Nigeria. 2018;45(3):159\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSemary SF, Abdel Rahman H, Elkinaai N, Zaky I, Nagy N, Salem S, et al. Prognostic Factors and Treatment Outcome of Relapsing and Refractory Pediatric Mature B-cell Non-Hodgkin Lymphoma, Children\u0026rsquo;s Cancer Hospital Egypt Experience. J Pediatr Hematol Oncol. 2023;45(6):e757.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJourdain A, Auperin A, Minard-Colin V, Aladjidi N, Zsiros J, Coze C, et al. Outcome of and prognostic factors for relapse in children and adolescents with mature B-cell lymphoma and leukemia treated in three consecutive prospective Lymphomes Malins B protocols. A Societe Francaise des Cancers de l\u0026rsquo;Enfant study. Haematologica. 2015;100(6):810\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAydin B, Akyuz C, Kalkan N, Kurucu N, Varan A, Yalcin B et al. FAB LMB 96 Regimen for Newly Diagnosed Burkitt Lymphoma in Children: Single-center Experience. J Pediatr Hematol Oncol. 2019;41(1).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMukhtar F, Boffetta P, Risch HA, Park JY, Bubu OM, Womack L, et al. Survival predictors of Burkitt\u0026rsquo;s lymphoma in children, adults and elderly in the United States during 2000\u0026ndash;2013. Int J Cancer. 2017;140(7):1494\u0026ndash;502.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAlvarez E, Le T, Kahn J, Winestone L, Li Q, Keegan T. Comorbidities and socioeconomic status are predictors of survival in children and young adults with Burkitt lymphoma. Leuk Lymphoma. 2021;62(11):2804\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHuang S, Jin L, Yang J, Duan Y-L, Zhang M, Zhou C-J, et al. Treatment outcome in children with central nervous system-positive Burkitt lymphoma using only intrathecal and systemic chemotherapy combined with rituximab. Chin Med J (Engl). 2021;134(11):1329\u0026ndash;34.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePatel A, Sharma MC, Mallick S, Patel M, Bakhshi S. Poor performance status, urban residence and female sex predict inferior survival in pediatric advanced stage mature B-NHL in an Indian tertiary care center. Pediatr Hematol Oncol. 2018;35(1):23\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWoessmann W, Zimmermann M, Meinhardt A, Mueller S, Hauch H, Kn\u0026ouml;rr F et al. Progressive or Relapsed Burkitt Lymphoma or Leukemia in Children and Adolescents after BFM-type First-line Therapy. Blood. 2020;blood.2019003591.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBuckle GC, Collins JP, Sumba PO, Nakalema B, Omenah D, Stiffler K, et al. Factors influencing time to diagnosis and initiation of treatment of endemic Burkitt Lymphoma among children in Uganda and western Kenya: a cross-sectional survey. Infect Agent Cancer. 2013;8:36.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Burkitt Lymphoma, treatment outcomes, survival rate, Mortality predictors, Tanzania","lastPublishedDoi":"10.21203/rs.3.rs-7810619/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7810619/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Burkitt lymphoma (BL) is an aggressive B-cell lymphoma predominantly affecting children in sub-Saharan Africa. It constitutes 50-70% of pediatric non-Hodgkin lymphomas in the region. In Tanzania, understanding the treatment outcomes and one-year survival rates at two major oncology centers can inform strategies to enhance survival.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethodology\u003c/strong\u003e: This retrospective cohort study analyzed children under 18 diagnosed with Burkitt lymphoma and treated at two tertiary care hospitals between January 2020 and December 2022. The study utilized Stata 18 to analyze data from medical records, focusing on demographic and clinical characteristics, Kaplan-Meier survival analysis, and Cox proportional hazards models to identify mortality predictors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: The study analyzed 72 children with Burkitt lymphoma (mean age: 5.8 years), predominantly male (70.8%), with 52.8% from rural areas. Tumor sites were mainly mandibular (47.2%) and abdominal (41.7%). Treatment outcomes varied between hospitals: KCMC had a higher complete remission rate (61.3%) compared to BMC (36.6%), while BMC experienced higher relapse (19.5%) and treatment abandonment rates (22.0%) than KCMC (6.5% and 3.2%, respectively). The one-year post-treatment survival rate was 75% overall, with a significantly longer mean survival time at KCMC (37.1 months) versus BMC (16.4 months). Key predictors of mortality included bone marrow involvement (AHR=32.48) and CNS involvement (AHR=34.00).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: The study reveals a 75% one-year survival rate for children with Burkitt lymphoma in Tanzania, surpassing the WHO's 2030 target. However, high treatment abandonment, relapse, and death rates, along with low complete remission rates, pose significant challenges. Key factors contributing to poor prognosis include CNS and bone marrow involvement. The study recommends comprehensive interventions, improved care access, and exploring alternative treatments like stem cell transplantation.\u003c/p\u003e","manuscriptTitle":"Childhood Burkit Lymphoma: The Treatment Outcomes, Survival Rates, and Predictors of Mortality at Two Tertiary Hospitals in Tanzania","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-01 08:11:20","doi":"10.21203/rs.3.rs-7810619/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-01-01T08:29:07+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-21T08:54:08+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-18T08:23:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"211458105172876041431042874555682858771","date":"2025-12-02T11:22:41+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"53861847959189367770475620227926107235","date":"2025-12-01T18:09:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"270008815030837749243994027337013166258","date":"2025-12-01T17:11:20+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-11-24T12:54:39+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-18T10:30:57+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-18T10:29:17+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pediatrics","date":"2025-10-08T18:27:24+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d9dc41d7-93f2-4a46-93c6-49c92c2b0877","owner":[],"postedDate":"December 1st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-19T16:08:18+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-01 08:11:20","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7810619","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7810619","identity":"rs-7810619","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}