Demographics and Survival Outcomes of Burkitt Lymphoma in the US: A Hospital-Based Study from the National Cancer Database with Focus on Hispanics
Authors: Vallejo Sergio A. , Mendiola Victor Ramon , Michalek Joel , Liu Qianquian , Diaz Duque Adolfo Enrique 
Published: December 2023

BACKGROUND: Burkitt lymphoma (BL) is an aggressive B cell non-Hodgkin lymphoma primarily caused by MYC gene deregulation on chromosome 8 ( BloodPMID: 33171490). In the US, both sporadic and immunodeficiency-associated variants of BL are common, and their treatment and prognosis are generally similar ( BloodPMID: 15265787). BL is typically diagnosed at a median age of 30. However, the underrepresentation of Hispanics (HI) in previous studies has led to an incomplete and inaccurate representation of this population. ( J Clin OncolPMID: 9704731) To address this knowledge gap, a comprehensive nationwide study is underway to investigate the demographic, clinical, and survival outcomes of HI and non-Hispanic (NH) patients with BL.
METHODS: Data from BL patients in the US (reported to NCDB between 2004 and 2019) were analyzed. Demographics, treatments, and overall survival (OS) were compared across ethnic groups. Kaplan-Meier and Cox regression analyses OS between HI and NH. Multivariate analysis and propensity score matching adjusted for age, stage, co-morbidity score, insurance status, facility type, and great circle distance.
RESULTS: Among the 11,015 BL patients analyzed, 12% were HI and 84% were NH. Most were male (HI 76%, NH 74%) and diagnosed before age 65 (83% vs.72%). HI patients were younger (mean 47 years) than NH patients (mean 52 years) (p-value &lt;0.001). Both groups were predominantly white (HI 90%, NH 82%), and stage IV was the most common (HI 52%, NH 52%). HI patients had a higher comorbidity burden (22%) with Charlson-Deyo Scores ≥2 compared to NH patients (16%) (p-value &lt;0.001).
Both groups had more government-sponsored insurance (HI: 42%, NH: 42%), but HI had a significantly higher uninsured percentage (16%) compared to NH (5.4%) (p&lt;0.001). Regarding Census Median Income (2008-2012) HI's most prevalent bracket was $35,000 - $45,999 (27%), while NH's was $46,000+ (42%). HI had more median incomes below $30,000 (24%) than NH (13%) (p&lt;0.001). HI patients had a shorter median distance to the reporting hospital (7.5 miles) compared to NH patients (11.5 miles) (p&lt;0.001).
In survival analysis, HI had higher 2, 5, and 10-year survival rates (64%, 60%, and 53%, respectively) compared to NH (69%, 54%, and 47%, respectively). The median survival time (MS) was 11.4 years for HI and 7.7 years for NH, favoring HI (p=0.003). Independently, on multivariate analysis, private insurance type was associated with higher OS (HR 0.69, CI 0.59-0.80, p&lt;0,01). Interestingly, the propensity-matched analysis showed a significant MS difference between HI vs NH (6.22 vs. 2.77 years).
CONCLUSION: The survival analysis conducted in this study revealed a significant and noteworthy difference in favor of HI patients with BL, despite their lower insurance coverage and income compared to NH patients. This finding could be attributed to their younger age at diagnosis, although both groups had similar burdens of comorbidities. Additionally, for both cohorts, private insurance type emerged as a significant prognostic factor in the multivariate analysis. These findings highlight the impact of ethnic and economic variations on oncological outcomes in BL for HI. This prompts further exploration of potential protective factors, unique disease characteristics, or access to improved treatments in this population. Understanding the underlying reasons for these differences could pave the way for targeted interventions and improved care for patients from diverse ethnic and economic backgrounds.