A national analysis of Burkitt lymphoma in the Hispanic community.
Authors: Alhaj Sara , Schmelz Jacob , Liu Qianqian , Michalek Joel , Diaz Duque Adolfo Enrique 
Published: June 2023

e18818

Background: Burkitt Lymphoma (BL) is an aggressive disease that accounts for 1% to 5% of non-Hodgkin B-cell lymphoma. Outcomes of the disease relies heavily on prompt diagnosis, evaluation, and management by multi-disciplinary healthcare team. Hence racial and ethnic inequities can play a role in the prognosis of BL. This study used national population-based analysis to explore the disparities between Hispanics (HI) and Non-Hispanics (NH) with BL in management and survival. Methods: Data were analyzed on Burkitt Lymphoma patients in the United States reported to the Surveillance, Epidemiology, and End Results (SEER) database. SEER contains the most comprehensive population-based cancer information in the U.S., covering approximately 27% of the total US population, and up to 36% of HI alone. Racial groups analyzed included NH, HI, blacks, and Asians/Pacific Islanders. Patient characteristics, age-adjusted incidence rate, and survival rate were compared across ethnic groups. Stratification by age, gender, and stage at diagnosis was considered. Kaplan-Meier and Cox regression analyses were used to compare overall survival (OS). Multivariate analysis and propensity score matching were performed with adjustment for age, stage and B-symptoms. Results: Of 6214 of BL patients, 19% were HI, and 80.4% NH. 70% of HI were male, compared to 73% of NH. The majority of HI (52%) and NH (41%) were diagnosed in the age bracket of < 40 (p = < 0.001). The median age at diagnosis was 39 for HI vs. 46 for NH (p < 0.001). The majority of HI (29%) were diagnosed between years (2010-2014), compared to majority of NH (28%) who were diagnosed between years (2005-2009) (p = < 0.001). Most of HI and NH were whites (96% vs 77%), followed by blacks (2% vs 12%). For stage, the majority of HI (35%) and NH (38%) were stage IV (p = < 0.001). In terms of radiation, 7% of HI received it, compared to 7% of NH (p = 0.51). Finally, the survival probability at 2, 5 and 10 years of HI vs NH were (0.619 vs 0.589), (0.608 vs 0.548), and (0.569 vs 0.492), respectively. The median survival time was 16.8 years for HI, vs 9.1 years for NH; and there was overall survival difference favoring HI with (p = < 0.0001) On multivariate analysis, those patients who were older than 80 and between 60 to 80 had worse OS compared to those younger than 60, with HR 6.48 (95% CI: 5.5 – 7.6 ) and 2.7 (95% CI: 2.4 – 3) respectively. Those who were at stage III and IV, had worse OS than those at early stage (I/II) with HR 1.4 (95% CI: 1.1 – 1.7) and HR 2.5 (95% CI: 2.1 – 2.9), respectively. Conclusions: The data analysis demonstrates BL to favor HI over NH in survival and outcome. This analysis illustrates that ethnicity does not alter oncological prognosis in BL for HI in the US. Exploration of etiologies of BL, as in sporadic, endemic, or immunodeficiency-related, can provide an improved understanding of our observation. Assessing each group's social determinants of health is also warranted to further define this significant difference in survival.