P3.P311: Racial Disparities in Disease-Specific Survival in Pediatric Patients with Burkitt Lymphoma

Background: Burkitt lymphoma (BL) is an aggressive, B-cell non-Hodgkin lymphoma (1). The endemic form is found in equatorial Africa and Papua New Guinea whereas the sporadic form is found elsewhere. In the United States, sporadic childhood BL is most commonly reported in White males three to five years of age, with the lowest incidence in Black patients (2,3). In adult BL patients, non-Hispanic Black patients are associated with worse overall survival (4), however there is a paucity of literature examining BL disease-specific survival (DSS) outcomes in the pediatric population. The goal of this study was to investigate racial patterns in disease-specific survival (DSS) of pediatric patients with BL.

Methods: The Surveillance, Epidemiology, and End Results (SEER) database was queried to identify pediatric patients ages 0-19 diagnosed with microscopically-confirmed cases of BL (ICD-O03 histology code 9687/3) between 2000-2020. Statistical analysis, including Chi-squared, Kaplan-Meier and log-rank, and multivariate Cox proportional hazards, was completed using SPSS version 29.0. Statistical significance was set at p< 0.05.

Results: A total of 1,150 pediatric patients with BL were identified, and the overall age-adjusted incidence rate was 2.46 per one-million (95% confidence interval [CI] 2.32-2.60). The greatest number of patients identified as White (60.7%), male (80.6%), and ages 5-9 (32.7%). The incidence rates of BL in Black (1.71 per one-million; 95% CI; p< 0.05), Asian or Pacific Islander (2.32 per one-million; 95% CI 1.89-2.82; p< 0.05), and Hispanic children (1.64 per one-million; 95% CI 1.44-1.87; p< 0.05) were significantly lower than in pediatric White children (3.21 per one-million; 95% CI 2.97-3.46). Univariate Kaplan-Meier analysis revealed that the 5- and 10-year disease-specific survival (DSS) rates for Black children (86.0% and 85.0%) were significantly lower than those observed in White (92.0% and 91.0%; p=0.044) and Hispanic children (94.0% and 94.0%; p=0.007). Multivariate analysis adjusting for age at diagnosis, race and ethnicity, annual income, rural-urban living, and disease stage revealed that only Black children experienced a significant increase in disease-specific mortality risk when compared to White children (adjusted hazard ratio [aHR] 2.15; 95% confidence interval [CI] 1.05-4.39; p=0.036).

Conclusion: Black pediatric patients demonstrate worse DSS when diagnosed with BL, as seen in adult patients. Even after adjusting for potential confounding variables, this mortality risk persisted. In accordance with existing studies, we found the greatest incidence of BL in white children (2). However, this is the first study to our knowledge to identify the racial disparities in DSS. One potential explanation behind the observed disparities involves EBV, which is implicated in the pathogenesis of BL and Black children are associated with higher EBV antibody titers. (5,6). There is an urgent need for research to delve deeper into the biological and social determinants of health disproportionately affecting minority communities, including pediatric populations diagnosed with BL.