Biochemical indices of Burkitt's Lymphoma clinial relevance in prognosis and management
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Date
2009-07-12
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Abstract
Endemic Burkitt’s lymphoma (eBL) is a juvenile malignant neoplasm of B-lymphocyte
origin, markedly affected by climate, vegetation and geographical location. All outpatient
clinical records of patients histologically and/or clinically diagnosed of BL
from January, 2000 to December, 2007 at the Komfo Anokye Teaching Hospital,
Ghana, a country within the malaria and lymphoma belts of the world, were reviewed in
a real country-based cross-sectional retrospective study. The effect of cyclical
chemotherapy (Cyclophophamide, Vincristine, Methotrexate and Prednisolone) on
serum lactate dehydrogenase (LDH), creatinine (Crt), sodium (Na), potassium (K),
phosphorus (Phos), calcium (Ca), chloride (Cl) and uric acid (UA) in relation to
treatment outcome in 76 newly diagnosed BL patients was also studied in a longitudinal
prospective study . A mean age of 6.9 2.7 (mode: 7; range: 1-16) was observed. Males
generally dominated in incidence (M: F= 1.43:1, p< 0.001) and significantly with facial
presentation (p<0.05). Females weakly dominated in abdominal presentations (p>0.05).
Age 4-8 years was the high risk range (p< 0.001) for both sexes. Males were affected
early in life (4-7 years) compared to their female counterparts (6- 11 years). Of the 551
cases reviewed, 48.3%, 32.7%, 15.8% and 3.3% were tumour presentation(s) involving
the face, abdomen, combined facial and abdominal and either facial or abdominal with
central nervous system (CNS) involvement (usually paraplegia) respectively. An
intriguing observation was evident between facial and combined facial and abdominal
cases which exhibited direct reverse trends in incidence. Three regions within the forest
zone individually showcased significantly higher (p< 0.001) incidences compared to
their seven cohorts that constitute the coastal and savannah agro-ecological zones of
Ghana. No region was explicitly associated with any particular clinical presentation. In
addition to LDH and tumour stage which are known prognostic factors for high-grade
XV
non-Hodgkin’s lymphomas (NHLs), Crt (p< 0.001) and Cl (p= 0.039) were also
identified as independent prognostic factors for eBL with respect to overall survival
(OS) and were subsequently used in hazard modelling. LDH, Na and Ca showed
significant (p<0.05) changes during cyclical chemotherapy within treatment time points
and in comparism with healthy age-sex matched controls. Post intensive-treatment
outcome was found to the associated with the trend of serum LDH, UA, Na, K and Ca
after a three-month monitoring period. This study has shown that though BL can present
with demographic patterns in prevalence within a given geographical location, no
clinical characterisation can necessarily be found associated with such patterns.
However, serum LDH, Crt, Cl and tumour stage can serve as important prognostic
factors before chemotherapy, and serum LDH, UA, Na and K can be used for
monitoring of cyclical chemotherapy to enhance OS in eBL.
Description
A Thesis submitted to the Department of Biochemistry and
Biotechnology, Kwame Nkrumah University of Science and
Technology in partial fulfilment of the requirements for the degree
of
MASTER OF PHILOSOPHY
Faculty of Biosciences
College of science