Aspects of epidemiological and clinical features of patients with central nervous system burkitt's lymphoma in Kenya

Abstract

Background: Establishing characteristics of Central nervous System (CNS) Burkitt's lymphoma (BL) is essential as CNS disease is associated with poor treatment outcome. Objective: To document the characteristics of those cases of Burkitt's who had CNS disease at the time of presentation. Design: Prospective study of the clinical details of paediatric patients admitted and treated for Burkitt's lymphoma from January 1986 to December 1997. Setting: Kenyatta National Hospital and seven provincial hospitals in Kenya. Main outcome measures: For every histologically proven Burkitt's case, the following were documented; Age, sex, geographical area (province in Kenya), complaints, physical findings, Cerebral Spinal Fluid (CSF) cytology results, Human Immunodeficiencies Virus screening test result and anatomical sites of the disease at the time of starting therapy. Results: A total of 1005 BL cases were studied and 961(95.6 %) were aged between two and 15.4 years median age of six years consisting of males 587(61 %) and females 374 (39%) while 44(4.4%) cases between 16 and 57 years consisting of males 23(52%) and females 21(43%). The main complaints; headache, swelling mainly facial, abdominal distension and proptosis. Peak duration at presentation 4 and 8 weeks, range I to 26 weeks. Clinical evaluation demonstrated CNS in 5.6%, presenting as headache, blurring of vision and difficulties in walking. Physical examination noted para-paresis, ophthalmoplegia and cranial nerve palsies, while CSF demonstrated BL cells in 158(18.4%). Overall CNS BL was found in 161(16.8%), children and 39% adults. All were systemic and no primary CNS BL detected. Peak age was 11 to 15 years for children. Their provinces Eastern; 24.5%, Central 21.3%, and Rift Valley 23.4%, ethnic origins, Meru 29.5%, Kikuyu 23.9% and Kamba 23.7%. The sites of tumour for CNS cases were abdominal, combined sites, and skeletal while least in maxilla and jaw. Seventy one per cent of adults had both CSF BL and HIV infection. Conclusion: CNS-BL children cases were older, reduced M:F ratio; had skeletaVabdominal presentation and were from the Central province, Kikuyu tribe and a positive CSF cytology for malignant cells found in almost all cases with CNS disease at presentation. No primary CNS BL detected. Geographically, cases were from mainly the highlands of Kenya. High CNS disease in adults coincided with HIV positive serostatus.