1A review of the literature on childhood Burkitt lymphoma in Nigeria

Niger J Paed 2016; 43 (1): 1 – 7

REVIEW

Brown BJ

A review of the literature on child-

hood Burkitt lymphoma in Nigeria

DOI:http://dx.doi.org/10.4314/njp.v43i1.1

Accepted: 8th December 2015

Abstract : Background: Burkitt

toma as the most common. There

Lymphoma is common childhood

was a decline in the frequency of

Brown BJ (

)

tumour in sub-Saharan Africa but

Burkitt lymphoma in Ibadan from

Department of Paediatrics,

the lack of centralized database on

1960-2010 and in Lagos. Peak

University College Hospital,

Ibadan, Nigeria.

childhood cancer in Nigeria has

ages of occurrence ranged from 5-

Email: biosbrown@yahoo.com

made it difficult having a nation-

10 years, more males and children

wide picture of its occurrence in

from low socio-economic classes

the country.

were affected. Different centers

Objectives: This study was aimed

reported predominant involvement

at pooling published data from

of either the jaw or the abdomen

across the country with the hope

but there were slightly more cen-

of providing an overview of the

ters with predominance of the jaw.

profile of the disease in Nigeria.

Retrospective studies yielded an

Methods : literature search was

estimated survival of 15-23%

carried

out

Pub

Med/

while the Event Free Survival

MEDLINE and Cochrane data-

probabilities at two years was 43%

bases for all articles published

and 48% for the Nigerian centers

between January 1975 and July

that participated in an international

2015 using search strings such as

study.

children, cancer, Burkitt’s, epide-

Conclusion : Burkitt Lymphoma is

miology, prevalence, treatment

a common tumour in Nigeria. Es-

and Nigeria.

Based on specific

tablishment of Cancer registries

criteria, 39 studies were included.

for better data capture and funding

Results: Burkitt Lymphoma was

for better treatment outcomes is

the most common childhood ma-

recommended.

lignancy in most parts of the

country accounting for 18.3-

Key words: Burkitt Lymphoma;

65.0% of malignant tumours but a

Nigeria; childhood; tumours; can-

few centers observed Retinoblas-

cer

Introduction

other extranodal sites ⁴ . Epstein Barr virus (EBV) is

found in nearly all cases. Sporadic Burkitt lymphoma

Burkitt lymphoma is an aggressive B cell Non-

occurs worldwide; with no specific geographic or cli-

Hodgkin’s lymphoma characterized by a high degree of

matic association. It accounts for 1% – 2% of lymphoma

proliferation of the malignant cells and deregulation of

in adults and up to 40% of lymphoma in children in the

United States . The abdomen, especially the ileocecal

the c- MYC gene . It has three variants namely the en-

demic, sporadic and HIV – associated forms . The high-

area, is the most common site of involvement; other

est incidence of the endemic form occurs in the lym-

sites that may be involved include the ovaries, kidneys,

phoma belt lying between latitude 10 degrees north and

omentum, and Waldeyer’s ring. Only about 15% of

south of the equator and characterized by malaria

cases of sporadic Burkitt Lymphoma harbor the EBV

genome . Immunodeficiency-associated Burkitt lym-

holoendemicity . It is therefore common in Tropical

Africa and in Papua New Guinea .

phoma occurs mainly in patients infected with HIV but

has also been reported in organ transplant recipients .

Endemic Burkitt lymphoma refers to those cases occur-

Nigeria is the most populous country in Africa and the

ring in African children, usually 4 – 7 years old, involv-

country’s 2006 Population and Housing Census placed

the country’s population at 140,431,790 . It is divided

ing the bones of the jaw and other facial bones, as well

as kidneys, gastrointestinal tract, ovaries, breast, and

into a Federal Capital Territory and thirty-six states and

the states are divided into six geopolitical zones: North-

volving all childhood malignancies including leukae-

West, North-East, North-Central, South-East, South-

mias and solid tumours. Studies that were based on solid

South, and South-West. The country lies on the west

tumours alone were analyzed separately and the ranking

coast of Africa between latitudes 4º16' and 13º53' north

of Burkitt lymphoma stated but frequency figures down-

and longitudes 2º40' and 14º41' east and therefore falls

played since they would not be representative of the

within the lymphoma belt . Burkitt lymphoma is there-

entire spectrum of childhood tumours.

fore expected to be common in Nigeria, given its geo-

graphical location. Studies from several states of the

A total of 39 articles on Burkitt Lymphoma in Nigeria

country report Burkitt Lymphoma to be the most com-

were reviewed. Sixteen studies were from the south west

mon type of cancer in children

9 – 11

but a few have re-

zone constituting the majority, followed by the North

ported the contrary

12,13

. A centre within the country has

West, south east and north central zones with 8, 7 and 6

reported a downward trend in the relative frequency of

studies respectively while the south-south and north east

zones had two and one articles respectively , one article

Burkitt Lymphoma with respect to other tumours but

this has not been appraised in most parts of the country

was based on 2 centres). Clinical or clinic-pathologic

. In terms of clinical presentation, whilst some centres

studies were used for analysis of socio-demographic

have reported the jaw or face as the predominant site

features and predominant sites of tumour involvement

affected

11,14

, others have reported the abdomen as the

and in this regard, emphasis was placed on studies that

most common site

15,16

included all tumours confirmed either by cytology of

fine needle aspirate or histology from a surgical biopsy.

Incidentally, there is no national cancer registry or data-

Studies based exclusively on surgical biopsy specimen

base to provide a general view of the situation nation-

were analyzed separately and given less emphasis be-

wide. There is also paucity of population based Cancer

cause the usual method of diagnosing Burkitt lymphoma

registries and many of publications on childhood cancer

in Africa is through cytology of fine needle aspirates of

are based on reports from Pathology departments or

accessible tumour and so analyzing only studies based

clinical reviews. There is therefore lack of national inci-

surgical biopsies is likely to exclude a significant pro-

dence data for the disease which could serve as baseline

portion of cases and therefore introduce bias to the re-

sults .

data and guide policy formulation towards management

and control. This is important given the association of

For centres with multiple publications on Burkitt lym-

the tumour with malaria and therefore the potential to

phoma over time, the most recent was used for preva-

control its occurrence with malaria control measures .

lence figures. However, for analysis of trend, all studies

The aim of this study was to compile published data on

that met the inclusion criteria over time were used.

Burkitt lymphoma across the country in order to summa-

rize them and provide an overview of the national pat-

tern of the disease. The objectives of this study were to

Results

describe the relative frequency, socio-demographic fea-

Prevalence

tures, predominant clinical sites of involvement and

treatment outcomes of Burkitt lymphoma in Nigeria.

Ten centres reported relative frequency of Burkitt lym-

The ultimate aim was to provide a summarized report

phoma among all cases of childhood malignant diseases

that could serve as a proxy for generalizable data in the

confirmed cytologically or histologically (Table 1).

absence of a centralized database for childhood cancer.

Burkitt lymphoma was the commonest in eight of the

In addition, it was hoped that any regional differences in

centres namely Enugu, Zaria, Jos, Ekiti, Calabar, Sa-

pattern would be highlighted by this review.

gamu, Abia and Gwagwalada with prevalence ranging

from 18.3 to 65.0% of malignant tumours of child hood

in the various centers

9 – 11,18 – 22

. These centres are spread

across the FCT and five geopolitical zones but excluding

Methodology

the north east geopolitical zone. Retinoblastoma was the

most common tumour in two centres namely, Ibadan

This was a review of published scientific literature on

and Kano with Burkitt lymphoma being the second most

common cancer in both cities

12,13

Burkitt lymphoma in Nigeria between January 1975 and

July 2015. Literature search was performed on Pub-

Med / MEDLINE and Cochrane databases for all articles

Studies from seven centres were restricted to solid tu-

using search strings or key words such as children, can-

mours; Burkitt lymphoma was the most common solid

cer, Burkitt’s, epidemiology, prevalence, treatment and

tumour in four centres namely Sokoto, Ilorin, Port Har-

23 – 26

Nigeria. The reference list of articles were also checked

court and Ile-Ife as shown in table 2

. In the fifth

for other articles that were not detected by the biblio-

centre, Zaria, Burkitt Lymphoma and Retinoblastoma

were of equal frequency and ranked highest . Out of

graphic search. The inclusion criteria for each analysis

depended on the specific objective targeted by that

the remaining two centres, Jos reported Rhabdomyosar-

analysis. In general, only studies based on cases from

coma as the predominant solid tumour accounting for 31

cancer registries or histopathology departments or clini-

percent of the tumours with Burkitt Lymphoma being

cal studies confirmed histologically or cytologically

the third most common and accounted for 13.8 percent

were included. For analysis of relative frequency of

of the tumours while in Lagos, Retinoblastoma was

Burkitt lymphoma, emphasis was placed on studies in-

reported to be the predominant tumour and accounted

for 21% of the tumours whereas Burkitt Lymphoma

accounted for only 2% of the tumours

28,29

Table 1: Frequency of Burkitt Lymphoma among all childhood cancers in different cities of Nigeria

Study

Year of

City/State

Geopolitical

Most Common

Sample size

Frequency of

Data Source

Publication

Zone

cancer

Burkitt Lymphoma

Ekanem

1992

Calabar

South south

Burkitt Lymphoma

18.3

Ward admissions

Ocheni

2005

Enugu

South east

Burkitt Lymphoma

24.1

Cancer Registry

Agboola

2009

Sagamu

South west

Burkitt Lymphoma

36.0

Pathology department

Mohammed

2009

Zaria

North west

Burkitt Lymphoma

329

27.0

Cancer registry/ hospital records

Awolola

2011

Ekiti

South west

Burkitt Lymphoma

28.6

Pathology department

Okpe

2011

Jos

North-central

Burkitt Lymphoma

48.9

Ward admissions

Ochicha

2012

Kano

North west

Retinoblastoma

438

19.9

Pathology and Haematology

Laboratories

Offiong

2012

Abuja

Federal Capital

Burkitt Lymphoma

43.5

Ward admissions

Territory

Babatunde

2015

Ibadan

South west

Retinoblastoma

625

11.7

Pathology department

Chineke

2015

Abia

South east

Burkitt Lymphoma

65.0

Clinical/pathology department

Table 2: Frequency of Burkitt Lymphoma among childhood solid malignant tumours in different cities

Study

Year

City/State

Geopolitical

Patient popula-

Tumour spec-

Commonest

Sample

Frequency

Data Source

Zone

tion

trum

cancer

size

of Burkitt

Lymphoma

Adelusola

1995

Ile-Ife

South-west

Hospital-based

All solid tumours

Burkitt Lym-

157

69.0

Pathology department

phoma

Seleye-

2005

Port

South-south

Hospital-based

All solid tumours

Burkitt Lym-

173

41.6

Pathology department

Fubara

Harcourt

phoma

Malami

2005

Sokoto

North-west

Hospital-based

All solid tumours

Burkitt Lym-

158

35.5

Pathology department

phoma

Samaila

2009

Zaria

North-west

Hospital-based

Histologically

Burkitt Lym-

189

14.3 each

Pathology Department

diagnosed cases

phoma &

only

Retinoblas-

toma

Akinde

2009

Lagos

South-west

Hospital-based/

Histologically

Retinoblas-

274

2.0

Pathology department

outside

diagnosed cases

toma

only

Tanko

2009

Jos

North- cen-

Hospital-based

Histologically

Rhabdomyo-

181

13.8

Cancer registry

tral

diagnosed cases

sarcoma

only

Omotayo

2013

Ilorin

North-central

Hospital-based

Histologically

Burkitt Lym-

261

44.4

Pathology department

diagnosed cases

phoma

only

All solid tumours = diagnosed from cytology of fine needle aspirate and histology of tissue biopsy

Trend in relative frequency of Burkitt Lymphoma

Lymphoma in Enugu.

A review by Ojesina et al observed a decline in preva-

lence in Ibadan from 51.5% in the period 1960 to 1972

Age distribution

reported by Williams , to 37.1 % in the period 1973 to

1990 reported by Akang

and subsequently 19.4% in

Fifteen studies described peak ages of occurrence of

the period 1991-1999 reported by Ojesina et al . The

Burkitt Lymphoma in children while two studies that

11.7% reported by Babatunde et al for the period 1991-

included children and adults described median ages. Out

2010 confirms a consistent decline in the relative fre-

of the fifteen studies on children, fourteen spread across

quency of Burkitt lymphoma in Ibadan over time .

all geopolitical zones reported peak ages of 5-10 years

Similarly, a decline in the frequency of Burkitt Lym-

(10,11,13 – 16,19,22,23,25,27,30,39 – 41) . Only one study

phoma among solid tumours has been reported in Lagos;

on children, from Sagamu reported a peak age of 1-5

from 19.6% reported by Tijani et al in the period be-

years (18). Out of the two studies that included children

and adults, Kagu et al in Ile-Ife reported a median age

tween 1974 and 1978 in which it ranked first through,

9.5% reported by Akinsulie et al

in the period 1988-

of 9 years while Obafunwa and Akinsete reported a me-

dian age of 10 years .

1998 in which it ranked third to, 2% reported by Akinde

et al for the period 2000-2007.

Sex distribution

In Enugu, South eastern Nigeria, Ocheni et al

re-

viewed the relative frequency of Burkitt lymphoma over

Fifteen studies from nine centres across northern and

four time periods. The relative frequency of Burkitt

southern Nigeria described the sex distribution of pa-

lymphoma was 37% between 1976-80 reported by

tients with Burkitt lymphoma and all reported male pre-

Agugua and Okeahialam , 26.5% between 1978-82

dominance with a male: female ratio ranging from 1.2-

reported by Obioha et al , 25.3% from 1989-98 re-

2.7: 1(10,13 – 16,19,22,23,27,30,39 – 42,44,45).

ported by Onwasigwe et al

and 24.1% between 1999-

2004 reported by Ocheni et al . Considering the period

Socio economic status

between 1978 and 2004, there does not seem to have

been an appreciable change in the frequency of Burkitt

Studies on Burkitt Lymphoma in Nigeria that have de-

scribed the socio economic status of children have usu-

while that which had the jaw as the predominant site

ally reported that parents of majority of affected children

was published in 2011. Therefore, using the more recent

belong to the low socio economic class (SEC) but re-

data from each centre with multiple figures, the jaw was

porting format has also lacked uniformity for summari-

predominant in five centres and the abdomen in four out

zation or comparability. In a retrospective study in

of the nine centres studied.

Ibadan, south west Nigeria, by Aderele and Antia: out of

133 children studied, occupation of 121 fathers was

Treatment

available- 42% were subsistence farmers fathers with no

formal education, 20% were traders while 37% were

Seven studies that met the inclusion criteria described

artisans like carpenters, drivers, tailors or casual labour-

treatments given comprising six local studies and one

ers, only one father an assistant superintendent of Police

international multicenter study. The international study

had a relatively high income . A prospective study by

was included because although it involved three African

the same authors, revealed that none of the children be-

countries, survival rates for the Nigerian centres where

longed to the high social class but most of the patients

presented separately. The local studies were all retro-

were from the lowest socio-economic classes including

spective and each used a variety of treatment regimens

58% from class V, the lowest social class . Oguonu et

but the predominant regimens used in each study are

al in Enugu, south eastern Nigeria, reported that 89%

shown in table 3. The most commonly used regimen

of children with Burkitt lymphoma lived in rural areas

consisted of Cyclophosphamide, Oncovin and Meth-

and most patients belonged to the low SEC 75% of them

otrexate (COM). Other drug treatments given included

Cyclophosphamide, Methotrexate and prednisolone ,

being from the lowest socio economic class and 54% of

parents illiterate. Another study from south eastern Ni-

monotherapy with any of cytosine arabinoside, meth-

, cyclophosphamide and

revealed that 61.5% of Burkitt

otrexate, nitrogen mustard

15,47

geria, by Chineke et al

surgery

15,39

Lymphoma patients in Abia state were form a low socio

. In addition, intra thecal therapy was given

-economic class. Ibrahim et al in Sokoto reported that

using cytosine arabinoside or methotrexate or both on

different days

16,39,42,47

all parents in their study belonged to the low income

. In some instances, treatment

groups, none had formal education and all mothers were

never took place or was abandoned due to financial con-

straints in procurement of chemotherapeutic agents .

housewives. In summary, most of the parents were of

the low socioeconomic class and this ranged from 61.5

Complete response rate (defined by complete tumour

to 100% of patients where figures are stated.

regression) was less than 50% in all four studies in

which it was stated (table 3). Most patients had either

Clinical presentation

partial or non-response. Documented death was highest

in the study from Sokoto (85.2%) in which intrathecal

Eleven studies from nine centres that described the clini-

chemotherapy was not given. This was followed by an

cal features of patients with Burkitt Lymphoma were

earlier study in Ibadan (77%) in which intrathecal ther-

studied out of which the jaw was the predominant site

apy was given only occasionally. Assuming that the non

affected in five studies while the abdomen was the pre-

-responders and partial responders eventually died,

dominant site in the remaining six studies. The six stud-

analysis of the complete response rate and the docu-

ies in which the abdomen was the predominant site in-

mented deaths in the present study (with the exclusion

clude two from Ibadan, and one each from Enugu, Jos,

of the study from Zaria in which complete response rate

Zaria and Sokoto in which the abdomen occurring either

was not stated), would yield an estimated overall sur-

alone or in combination with other sites accounting for

vival rate that is at best 15-23%. In a recent multicenter

between 32 and 77.8 % of tumours(15,16,39,41,43,47).

funded study involving Kenya, Tanzania and Nigeria,

The five studies in which the jaw was the predominant

the International Network of Cancer Treatment and Re-

site affected include one each from Abia State,

search Protocol 03-06 was used. The event free survival

Maiduguri, Ile-Ife, Calabar and Jos; the jaw accounted

probabilities at 2 years for the two Nigerian centres that

for between 40.7 and 77 % of cases seen occurring ei-

participated were 43% at the University College Hospi-

ther alone or in combination with other sites

tal, Ibadan and 48% at Obafemi Awolowo University

(11,14,19,22,42). The study from Jos that had the abdo-

Teaching Hospital Complex (17).

men as the predominant site was published in 1992

Table 3: Treatment outcome for patients with Burkitt Lymphoma

Study

City

Year of

No. of

Predominant

Complete

Partial response

Loss to follow

Documented

Publica-

patients

patients not

chemotherapy

response % of

% of treated

up/Abandoned

deaths %

tion

treated

regimen

treated patients

patients

treatment %

Ad-

Ibadan

1979

CTX Monother-

48.8

77.0

erele&Antia

apy

Fasola

Ibadan

2002

COAP

22.8

57.9

17.5

Taqi

Zaria

1987

COM

Not stated

33.3

Ibrahim

Sokoto

1998

COM

Not stated

7.4

85.2

Oguonu

Enugu

2002

COMP

48.0

35.0

59.1

36.0

Kagu

Ile-Ife

2004

174

COM

29.3

77.9

20.7

CTX: cyclophosphamide

COAP: Cyclophophamide, Vincristine, Cytosine arabinoside, Prednisolone

COM: Cyclophophamide, Vincristine, Methotrexate

COMP: Cyclophophamide, Vincristine, Methotrexate, Prednisolone

Discussion

socio-economic class. They postulated that frequent

infections due to malnutrition to which children form

This review has provided an overview of the pattern of

low socio-economic background are prone, makes their

occurrence of Burkitt Lymphoma across Nigeria. With

immunity too weak to combat the Epstein Barr virus

which is associated with Burkitt Lymphoma . The pre-

the tumour being the most common childhood malignant

tumour in 10 out of 12 centres for whom data for all

sent review has shown that between 61.5 and 100 per-

cancers is available, it stands out as the most common

cent of children with Burkitt Lymphoma belong to the

childhood cancer nationwide, accounting for between

low socio-economic class. This suggests a role for low

18.3-65 percent of tumours. Our results also reveal

socio-economic status in the occurrence of the disease

Burkitt Lymphoma to be the most common malignant

probably due to associated immunosuppression from

childhood solid tumour in the country. This study has

malnutrition or poor malaria control from poor living

also shown that Retinoblastoma rather than Burkitt

conditions. However, controlled studies are required to

Lymphoma is the most common childhood cancer in

establish a firm association between Burkitt Lymphoma

Ibadan and Kano, situated in the south western and

and poverty. None-the-less, the difficulties in managing

northwestern geopolitical zones respectively

12,13

and the

affected children imposed by poverty such as difficulties

most common solid tumour in Lagos, also in the south

in investigations, use of suboptimal therapy and aban-

western zone of the country. Considering studies that

donment of treatment highlight the important role of

poverty in contributing to poor outcome in Nigeria

42,47

were based exclusively on solid tumours, Burkitt Lym-

phoma remained the commonest solid tumour in most

This calls for government support to treat children with

centres with the exception of Jos and Lagos. The placing

Burkitt lymphoma free of charge. Improvement in the

of Burkitt lymphoma as the third most common tumour

standard of living which is likely to reduce the incidence

in the review by Tanko et al from Jos needs to be in-

of the disease is also recommended.

terpreted with caution bearing in mind that Burkitt Lym-

phoma is mostly diagnosed through cytology of fine

Different epidemiologic forms of Burkitt Lymphoma are

needle aspirate and so the Jos study which was based on

characterized by particular clinical features. Whilst the

histology of solid tumours is likely to have an under-

endemic form usually presents with tumours of the fa-

representation of Burkitt Lymphoma . The predomi-

cial skeleton as the predominant site, the abdomen is

nance of Retinoblastoma among solid tumours in Lagos

usually the predominant site in the sporadic form of the

is similar to the finding in Ibadan which is in the same

disease(2). The present study has revealed that the jaw

geopolitical zone. However, the very low frequency of

and abdomen are the major sites affected in Nigeria, in

Burkitt lymphoma (2%) in the most recent study from

nearly equal proportions but with a slight predominance

Lagos is a striking feature probably due to the fact that

of the jaw. However, the age group affected and the geo-

Akinde et al used only histologically diagnosed cases

graphical location support the belief that the form seen

and so excluded cytologically confirmed cases which

in the country is the endemic form. There is no obvious

might have included cases of Burkitt Lymphoma.

geographical bias with the pattern as the northern and

southern regions of the country each has centres with

The downward trend in the frequency of Burkitt Lym-

jaw and abdominal predominant sites. The findings of

phoma in Ibadan over time from 51.5% reported by Wil-

this study are in keeping with those from other African

liams in 1960 to 11.7% reported by Babatunde et al in

countries in which the major sites affected are the face

the year 2010 is quite significant. This is similar to find-

and abdomen with slight preponderance of the face as

seen Ghana and Uganda

50,51

ings in Lagos revealed in the present study. Although

. The peak ages ranging

the exact cause is not clear, it has been attributed to im-

from 5-10 years observed in most centres in this review

provement in living conditions and better malaria con-

is also in keeping with findings in Kenya and Ugan-

49,51

trol measures, given the role of malaria in endemic

. The reason why a peak age of 1-5 years was ob-

served in Sagamu is not clear .

Burkitt Lymphoma. Knowledge of the factors responsi-

ble for this decline would be useful in proffering solu-

tions towards reducing the incidence of the disease.

Data on overall survival and event-free survival from

Incidentally, a similar trend was not observed in Enugu.

Burkitt Lymphoma in Nigeria are scarce. This study has

There is a lack of studies on trend of childhood cancer in

however revealed a poor outcome of treatment of the

other parts of Nigeria. Such studies, along with popula-

tumour in the country due to inability to pay for treat-

tion based incidence studies are necessary nationwide as

ment, frequent abandonment of treatment, use of mono-

epidemiological tools to guide the formulation of policy

therapy and loss to follow up. In some instances, 7.4 –

and measures aimed at cancer prevention and control.

77.9 % of patients abandoned treatment and up to 18.3

% could not receive treatment

41, 42

. The chemotherapeu-

The male preponderance of the disease nationwide is in

tic regimen most frequently used was the COM proto-

keeping with established findings in Uganda . This re-

col. Complete response rate in the retrospective reviews

view has shown the peak age of Burkitt Lymphoma in

was between 22.8 to 48.8 percent. A study on the pat-

terns of treatment failure in Ibadan by Williams et al

Nigeria to be between 5 and 10 years which is similar to

the highest age standardized incidence rate observed in 5

showed that patients with Partial response and Non-

-9 years in Kenya .

Response were all dead by the 10th observation month.

Aderele and Antia in Ibadan observed that 99 percent of

Consequently, the partial and non-responders in this

children with Burkitt Lymphoma belonged to the low

may be assumed to have died. Analysis of the complete

response rate and the documented deaths in the present

declining trend in its frequency. This may be due to im-

study (with the exclusion of the study from Zaria in

proving socioeconomic status and malaria control. Some

which complete response rate was not stated), would

areas regions experiencing this decline are observing

yield an estimated overall survival that is at best 15-23%

Retinoblastoma as the predominant childhood cancer.

in the retrospective studies. In the INCTR multicenter

The demographic features are in keeping with those in

study, the EFS probabilities for the Nigerian sites of 43

other parts of the World where endemic Burkitt Lym-

and 48 percent are better and reflect the improvement

phoma occurs. Affected families are poor and treatment

that may result from support in funding treatment . Our

outcomes bedeviled by financial difficulty in paying for

findings are also a sharp contrast to a 5 year survival of

treatment and abandonment of treatment. There is dearth

64.7% observed in a South African setting with better

of national data on incidence which calls for establish-

laboratory and treatment facilities .

ment of cancer registries to provide the true incidence of

the tumour. There is also a need for financial support for

treatment of and long term follow up of affected chil-

dren to facilitate improved outcomes and provide data

Conclusion

on survival.

Burkitt Lymphoma is the most common childhood ma-

lignancy in Nigeria but some parts of the country have a

References

Hartmann EM, Ott G, Rosenwald

Ocheni S, Okafor CO, Emodi IJ,

17. Ngoma T, Adde M, Githang J, Ova

A. Molecular biology and genetics

Ibegbulam OG, Olusina DB, Ike-

A, Kaijage J, Adeodou O, et al.

of lymphomas. Hematol Oncol

funa AN, et al. Spectrum of child-

Treatment of Burkitt lymphoma in

Clin North Am . 2008 ;22:807 – 23,

hood malignancies in Enugu, Ni-

equatorial Africa using a simple

vii.

geria (1999-2004). Afr J Med Med

three-drug combination followed

Orem J, Mbidde EK, Lambert B,

Sci . 2005;34:371 – 5

by a salvage regimen for patients

de Sanjose S, Weiderpass E.

10. Mohammed A, Aliyu HO. Child-

with persistent or recurrent disease.

Burkitt’s lymphoma in Africa, a

hood cancers in a referral hospital

Br J Haematol . 2012; 158: 749-62

review of the epidemiology and

in northern Nigeria. Indian J Med

18. Agboola AOJ, Adekanmbi FA,

etiology. Afr Health Sci .

Paediatr Oncol . 2009;30(Iccc):95

Musa AA, Sotimehin AS, Deji-

2007 ;7:166 – 75

– 8

Agboola AM, Shonubi AMO, et al.

Lavu E, Morewaya J, Maraka R,

11. Okpe E, Abok I, Ocheke I, Okolo

Pattern of childhood malignant

Kiromat M, Ripa P, Vince J.

S. Pattern of Childhood Malignan-

tumours in a teaching hospital in

Burkitt lymphoma in Papua New

cies in Jos, North Central Nigeria.

south-western Nigeria. Med J Aust .

Guinea 40 years on. Ann Trop

J Med Trop. Faculty of Medical

2009 ;190:12 – 4

Paediatr . 2005 ;25:191 – 7

Sciences, University of Jos ;

19. Ekanem IA, Asindi AA, Ekwere

Diebold J. Burkitt lymphoma. In:

2011;13:109 – 14.

PD, Ikpatt NW, Khalil MI. Malig-

Jaffe E, Harris N SH et al, editor.

12. Babatunde TO, Akang EEU, Ogun

nant childhood tumours in Calabar,

Pathology and Genetics of Tu-

GO, Brown BJ. Pattern of child-

Nigeria. Afr J Med Med Sci .

mours of Haematopoietic and

hood cancer in University College

1992;21:63 – 9

Lymphoid Tissues . Washington,

Hospital, Ibadan during 1991-2010

20. Awolola NA, Komolafe AO, Ojo

DC: IARC Press; 2001. p. 181 – 4.

and comparison with the previous

OO, Taiwo OJ, Odesanmi WO,

Blum KA, Lozanski G, Byrd JC.

three decades. Paediatr Int Child

Ajumobi KO. The spectrum of

Adult Burkitt leukemia and lym-

Health . 2015;35:144 – 50

malignant neoplasms in Ekiti State,

phoma. Blood . 2004;104:3009 – 20.

13. Ochicha O, Gwarzo AK, Gwarzo

south-west Nigeria. Nig Q J Hosp

Levine PH, Kamaraju LS, Con-

D. Pediatric malignancies in Kano,

Med . 2011;21:276 – 83

nelly RR, Berard CW, Dorfman

Northern Nigeria. World J Pediatr .

21. Offiong U. Childhood malignan-

RF, Magrath I, et al. The Ameri-

2012;8:235 – 9.

cies in University of Abuja Teach-

can Burkitt’s lymphoma regis-

14. Mava Y, Baba UA, Timothy SY,

ing Hospital Gwagwalada, Abuja,

try:Eight years' experience. Can-

Pius S, Ambe JP. Retrospective

Nigeria. Niger J Paediatr .

cer . 1982;49:1016 – 22

study of childhood burkitts lym-

2012 ;39:60 – 2

Gong JZ, Stenzel TT, Bennett ER,

phoma in north eastern Nigeria.

22. Chineke H N, Adogu P O U, Diwe

Lagoo AS, Dunphy CH, Moore

West Afr J Med . 2013;32:297 – 301

K C ECO and EMU. Occurrence

JO, et al. Burkitt lymphoma aris-

15. Aderele, WI & Antia, AU.

of Burkitt’s Lymphoma among All

ing in organ transplant recipients:

Burkitt’s Lymphoma in Children at

Childhood Tumors Seen in Abia

a clinicopathologic study of five

Ibadan: a review of 133 cases. Nig

State University Teaching Hospital

cases. Am J Surg Pathol .

J Paediatr . 1979;6:1 – 14

ABA, South East Nigeria (11

2003 ;27:818 – 27

16. Oguonu T, Emodi I, Kaine W.

Years Retrospective Study). Br J

National Population Commission

Epidemiology of Burkitt’s lym-

Med Med Res . 2015;6:533 – 7

(NPC) [Nigeria] and ICF Interna-

phoma in Enugu, Nigeria. Ann

23. Malami S, Dauda A, Pindiga U,

tional. Nigeria Demographic and

Trop Paediatr . 2002 ;22:369 – 74

Abimiku B, Abubakar D. A pathol-

Health Survey 2013. [Internet].

ogy frequency study of childhood

Abuja, Nigeria, and Rockville,

solid cancer in Sokoto. Sahel Med

Maryland, USA: NPC and ICF Interna-

J . 2006 ;8:106 – 9

tional. 2014 [cited 2015 Sep 4]. Avail-

able from: https://dhsprogram.com/

pubs/pdf/FR293/FR293.pdf

24. Omotayo J, Duduyemi B, Buhari

36. Agugua NE, Okeahialam T. Malig-

47. Fasola FA, Shokunbi WA, Falade

M, Anjorin A. Histopathological

nant diseases of childhood seen at

AG. Factors determining the out-

Pattern of Childhood Solid Tu-

the University of Nigeria Teaching

come of management of patients

mours in Ilorin: A 28-Year Retro-

Hospital (UNTH), Enugu, Nigeria.

with Burkitt’s lymphoma at the

spective Review. Am J Med Sci

East Afr Med J . 1986 ;63:717 – 23

University College Hospital

Med. Science 2013;1:105 – 9.

37. Obioha FI, Kaine WN, Ikerionwu

Ibadan, Nigeria--an eleven year

25. Seleye-Fubara D, Akani N. Solid

SE, Obi GO, Ulasi TO. The pattern

review. Niger Postgrad Med J .

Malignancies in Children and

of childhood malignancy in eastern

2002 ;9:108 – 12

Adolescents: Experience at the

Nigeria. Ann Trop Paediatr .

48. Wabinga HR, Parkin DM, Wab-

University of Port Harcourt Teach-

1989 ;9:261 – 5

wire-Mangen F, Nambooze S.

ing Hospital. Niger J Paediatr .

38. Onwasigwe CN, Aniebue PN, Ndu

Trends in cancer incidence in

2005 ;31:43 – 7.

AC. Spectrum of paediatric malig-

Kyadondo County, Uganda, 1960-

26. Adelusola KA, Odesanmi WO,

nancies in eastern Nigeria (1989-

1997. Br J Cancer . 2000 ;82:1585

Adejuyigbe O, Rufai OA, Duros-

1998). West Afr J Med .

– 92

inmi MA, Akinola NO. Malignant

2002;21:31 – 3

49. Mwanda OW, Rochford R, Moor-

solid tumours in Nigerian children.

39. Taqi AM, Yakubu AM. Presenta-

mann AM, Macneil A, Whalen C,

Cent Afr J Med . 1995;41:322 – 6.

tion and experience with the man-

Wilson ML. Burkitt’s lymphoma

27. Samaila MO. Malignant tumours

agement of Burkitt’s lymphoma

in Kenya: geographical, age, gen-

of childhood in Zaria. Afr J Paedi-

patients in Zaria. J Trop Pediatr .

der and ethnic distribution. East

atr Surg . 2009;6:19 – 23 .

1987;33:98 – 102

Afr Med J . 2004;(8 Suppl):S68 – 77.

28. Tanko NM, Echejoh GO, Manas-

40. Shehu UA, Adegoke SA Abdul-

50. Owusu L, Yeboah FA, Osei-Akoto

seh NA, Mandong MB, Uba AF.

salam U, Ibrahim M, Oyelami OA

A, Rettig T, Arthur FKN. Clinical

Paediatric solid tumours in Nige-

AO. Pattern of childhood malig-

and epidemiological characterisa-

rian children: a changing pattern?

nant tumours in two tertiary teach-

tion of Burkitt’s lymphoma: an

Afr J Paediatr Surg . 2009 ;6:7 – 10.

ing hospitals in Nigeria  : compara-

eight-year case study at Komfo

29. Akinde OR, Abdukareem FB,

tive study. Niger J Paediatr .

Anokye Teaching Hospital, Ghana.

Daramola AO, Anunobi CC,

2013;40:175 – 8

Br J Biomed Sci . 2010 ;67:9 – 14

Banjo AA. Morphological pattern

41. Ibrahim M, Rafindadi AH YM.

51. Orem J, Mulumba Y, Algeri S,

of childhood solid tumours in

Burkitt’s Lymphoma in Children at

Bellocco R, Mangen FW, Mbidde

Lagos University Teaching Hospi-

Sokoto. Niger J Med . 1998;7:115 –

EK, et al. Clinical characteristics,

tal. Nig Q J Hosp Med . 2009;

treatment and outcome of child-

19:169 – 74.

42. Kagu MB, Kagu BM, Durosinmi,

hood Burkitt’s lymphoma at the

30. Ojesina AI, Akang EEU, Ojemak-

Adeodu OO, Akinola NO, Ad-

Uganda Cancer Institute. Trans R

inde KO. Decline in the frequency

ediran IA, et al. Determinants of

Soc Trop Med Hyg . 2011;105:717

of Burkitt’s lymphoma relative to

survival in Nigerians with

– 26

other childhood malignancies in

Burkitt’s lymphoma. Afr J Med

52. Williams CK, Folami AO, Seriki

Ibadan, Nigeria. Ann Trop Paedi-

Med Sci . 2004;33:195 – 200

O. Patterns of treatment failure in

atr . 2002;22:159 – 63 .

43. Obafunwa JO, Akinsete I. Malig-

Burkitt’s lymphoma. Eur J Cancer

31. Williams AO. Tumors of child-

nant lymphomas in Jos, Nigeria: a

Clin Oncol . 1983;19:741 – 6.

hood in Ibadan, Nigeria. Cancer .

ten-year study. Cent Afr J Med .

53. Stefan DC, Lutchman R. Burkitt

1975;36:370 – 8.

1992;38:17 – 25

lymphoma: epidemiological fea-

32. Akang EE. Tumors of childhood

44. Abdullahi S, Hassan-Hanga F,

tures and survival in a South Afri-

in Ibadan, Nigeria (1973-1990).

Atanda a, Ibrahim M. Pattern of

can centre. Infect Agent Cancer .

Pediatr Pathol Lab Med .

childhood malignant tumors at a

2014 ;9:19

1996;16:791 – 800.

teaching hospital in Kano, North-

33. Tijani SO, Elesha SO, Banjo AA.

ern Nigeria: A prospective study.

Morphological patterns of paediat-

Indian J Cancer . 2014;51:259

ric solid cancer in Lagos, Nigeria.

45. Edington GM. The Burkitt lym-

West Afr J Med . 1995 ;14:174 – 80.

phoma in the northern savanna of

34. Akinsulie AO, Lesi FEA, Onifade

Nigeria. Prog Clin Biol Res.

EU, Bode CO BA. The Pattern of

1981;53:133 – 49

Paediatric Solid Tumours in La-

46. Aderele WI, Antia AU. Observa-

gos. Nig J Paediatr . 2000;27:47 –

tions on some aetiological factors

53.

in Burkitt’s lymphoma. Afr J Med

35. Ocheni S, Bioha FI, Ibegbulam

Med Sci . 1983;12:1 – 6

OG, Emodi IJ, Ikefuna AN.

Changing pattern of childhood

malignancies in Eastern Nigeria.

West Afr J Med . 2008 ;27:3 – 6.