Outcomes and factors affecting survival of children diagnosed with Burkitt’s lymphoma in Lacor Hospital

Abstract

Background: Burkitt’s lymphoma (BL) is the most common childhood cancer in Uganda with a prevalence of 28%. The incidence of BL has been reported to be even much higher in northern Uganda than elsewhere in Africa. Lacor Hospital has an oncology unit that treats BL and other solid tumors. The overall survival rate of the most common childhood cancer and the factors affecting it are unknown among the affected children living in the most endemic region in Africa. Objective: To determine the 5-year clinical outcomes and factors associated with survival of children with BL that received care from St. Mary’s Hospital Lacor. Method: This was a retrospective cohort study involving chart review for children diagnosed with Burkitt’s Lymphoma from January 2015 to December 2020 at St. Mary’s hospital Lacor. Relevant data was extracted and analyzed. Kaplan-Meier survival curves were used to estimate 5-year survival. Cox regression analysis was used to assess the prognostic factors and presented as hazard ratios with their 95% confidence interval at both bivariate and multivariate levels. Results: The five-year survival rate among children with known outcomes was 34.1%. Most patients (79.7%) presented with advanced-stage disease (Stage III or IV). Significant predictors of improved survival included higher baseline hemoglobin levels (median 11.0 g/dL vs. 9.0 g/dL), higher absolute lymphocyte counts (median 3.0 vs. 2.0 x10⁹/L), achieving clinical remission, and completing more chemotherapy cycles (median 6 vs. 2). Treatment abandonment was reported in 12.3% and loss to follow-up in 24.8% of cases. Regional disparities were noted, with higher adherence in West Nile and Karamoja compared to Eastern Uganda. Underweight status was nearly universal (97.3%), and HIV status was unknown (78%) of participants, limiting conclusions about its prognostic role. Conclusion: Survival of pediatric BL in Lacor Hospital is far below global statistics. Chemotherapy delivery was feasible though late-stage presentation, undernutrition, and high attrition rates severely limited survival outcomes. Early diagnosis, nutritional support, improved treatment adherence, and robust follow-up systems are urgently needed to improve survival in this vulnerable population. KEY WORDS: Burkitt’s lymphoma, pediatric cancer, Uganda, survival outcomes, treatment adherence, low-resource settings, chemotherapy, St. Mary’s Hospital Lacor.