Analysis of Nutrition Status and Outcomes for Pediatric Patients with Burkitt Lymphoma Treated in Mwanza, Tanzania

Introduction: Despite decades of improvement in outcomes for pediatric cancers in High-Income Countries (HICs), outcomes remain incredibly disparate as compared to those achieved in Low- and Middle-Income Countries (LMICs). While the source of this disparity is multifactorial, it is known that medical comorbidities, such as malnutrition, are seen in higher frequency in LMICs, and almost certainly contribute to poor outcomes. However, akin to other resource limitations in LMICs, there is a relative paucity of available cancer registries in LMICs to more completely characterize outcomes and associated comorbidities. Subsequently, at our study site, Bugando Medical Centre (BMC) in Mwanza, Tanzania, we aimed to understand the rate of malnutrition at presentation for a subset of our patients, those with Burkitt lymphoma, and its association with their outcomes at our site. We theorize that a more robust understanding of malnutrition and outcomes at our site will inform future interventions to improve the care of these patients at our site and in LMICs as a whole.

Methods: Historical patient data from were available from a recent IRB and local ethical board (NIMR) approved study. Records from pediatric patients with a diagnosis of Burkitt lymphoma treated at Bugando Medical Centre between 2016 and 2021 were analyzed. Anthropomorphic data including weight and height at time of diagnosis were available from these records. BMI Z scores were calculated use WHO criteria and these scores were used to assess for malnutrition using standard cutoffs.

Results: 82 pediatric patients with a diagnosis of Burkitt lymphoma were analyzed. Patients on average were 7.6 years old. A majority of patients (65%) were male. 28 patients (34%) met WHO criteria for malnutrition with 12 (15%) meeting criteria for severe malnutrition (Z score ≤-3). Little association between nutrition status assigned from BMI at diagnosis and outcomes were observed. 5 of 12 (42%) of the severely malnourished children were known to have survived as compared to 14 of 37 (38%) of patients with a normal BMI. These trends were similar when analyzing the under 5 years cohort which was theorized to be at greater risk for complication. 1 of 4 (25%) patients under 5 with severe malnutrition were known to have survived compared to 5 of 17 (29%) of patients under 5 with normal BMI. Treatment abandonment was felt to be a potentially confounding factor in these data with 26 of these 82 patients (32%) having abandoned.

Conclusions: Malnutrition was a common comorbidity at the time of diagnosis for our historic pediatric patients with Burkitt lymphoma treated at BMC in Mwanza, Tanzania. Outcomes as a whole, while poor, surprisingly did not show a clear association with nutrition status at diagnosis in this cohort. It is possible, however, that other factors, such as treatment abandonment, may have confounded these data. An additional limitation is that patients at diagnosis may have an effusion or edema which may influence the weight at diagnosis. Future investigations at our site will use Mid Upper Arm Circumference (MUAC), which is now collected as standard of care at our site. MUAC would likely be less influenced by the fluid status of these patients and subsequently improve the accuracy of the nutrition assessment. We posit that the continued investigation of malnutrition in these patients and their outcomes is needed in order to inform targeted interventions to address nutrition status and improve outcomes for these patients.