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Eosinophilia in children with endemic Burkitt lymphoma in Malawi as a prognostic factor for survival

In dieser Arbeit wurde gezielt die Frage untersucht, ob Eosinophilie bei Diagnosestellung eines endemischen Burkitt Lymphoms in Malawi einen prognostisch positiven Faktor für das Überleben darstellt. In diese retrospektive Studie wurden 479 Patienten, zwischen 1997 und 2009 in Malawi behandelt, eingeschlossen. Mittels uni- und multivariater Analyse wurde versucht unabhängige Einflussvariablen auf das 1-Jahres Ereignis-freie Überleben zu erfassen. Das mediane Alter lag bei 7.0 Jahre (M:F Ratio 1.8:1, Stadium I 14.4%, II 22.3%, III 46.8%, IV 15.2%). Der mediane Eosinophilen-Wert betrug 0.10 x 10³/µl. 25.5% der Kinder präsentierten initial mit Eosinophilie. Innerhalb der 12 Monate erlitten 36.3% der Patienten ein Rezidiv oder Tod, 16.1% blieben Tumor-frei. Die multivariate Analyse ergab, dass Patienten mit Stadien III, IV ein signifikant erhöhtes Risiko für ein Ereignis haben (chi² 0.019, exp(B) 1.579). Eosinophilie hatte keinen signifikanten Einfluss auf das ereignisfreie Überleben.

In this dissertation we analysed the hypothesis that eosinophilia in children with newly diagnosed endemic Burkitt lymphoma represents a positive prognostic factor for survival. In this retrospective study, data of 479 patients treated in Malawi from 1997 to 2009 was analysed. By means of uni- and multivariate statistical analyses we tried to identify independent variables influencing 1 year event free survival (1-EFS). Median age was 7.0 years (M:F ratio 1.8:1, Stage I 14.4%, II 22.3%, III 46.8%, IV 15.2%). Median eosinophilic count was 0.10 x 10³/µl. 25.5% of the patients presented initially with eosinophilia. Within the 12 months follow-up 36.6% of the children died or suffered relapse, 16.1% remaind in tumor-free status. Multivariate analysis showed patients with stage III,IV disease to have a significantly increased risk to suffer an event (chi² 0.019, exp(B) 1.579). Eosinophilia was not shown to correlate significantly with 1-EFS. Thus, our hypothesis was not proofed.

Titel: Eosinophilia in children with endemic Burkitt lymphoma in Malawi as a prognostic factor for survival
Verfasser: Schlau, Hannah Naomi GND
Gutachter: Rössig, Claudia
Organisation: FB 05: Medizinische Fakultät
Dokumenttyp: Dissertation/Habilitation
Medientyp: Text
Erscheinungsdatum: 16.04.2014
Publikation in MIAMI: 16.04.2014
Datum der letzten Änderung: 27.07.2015
Schlagwörter: endemisches Burkitt Lymphom; Eosinophilie; Risikostratifizierung; Überleben; positiv prognostischer Faktor; Malawi
endemic Burkitt lymphoma; prognostiv positive factor; survival; eosinophilia; risk stratification; Malawi
Fachgebiete: Medizin und Gesundheit
Sprache: Englisch
Format: PDF-Dokument
URN: urn:nbn:de:hbz:6-83359564722
Permalink: https://nbn-resolving.org/urn:nbn:de:hbz:6-83359564722
Onlinezugriff:
Inhalt:
1 INTRODUCTION........................................................................................................................ 1
1.1 Malawi......................................................................................................................... 1
1.2 Cancer in Malawi & Sub-Saharan Africa ..................................................................... 1
1.3 Burkitt Lymphoma ...................................................................................................... 2
1.4 Eosinophilia ................................................................................................................. 5
1.5 Hypothesis & Objective .............................................................................................. 6
2 METHOD AND MATERIALS ...................................................................................................... 6
2.1 Study design ................................................................................................................ 6
2.2 Data acquisition .......................................................................................................... 7
2.3 Diagnosis and testing methods ................................................................................... 7
2.4 Definitions and data management ............................................................................. 9
2.5 Statistical data analysis ............................................................................................. 12
3 RESULTS ................................................................................................................................. 13
3.1 Characterization of the patient population .............................................................. 13
3.1.1 General numbers........................................................................................... 13
3.1.2 Stage of disease ............................................................................................. 14
3.1.3 Localisation of tumour .................................................................................. 15
3.1.4 CNS involvement ........................................................................................... 16
3.1.5 Paraplegia ...................................................................................................... 16
3.1.6 Bone marrow involvement ........................................................................... 17
3.1.7 HIV status ...................................................................................................... 17
3.1.8 Blood counts ................................................................................................. 18
3.1.9 Parasitic infections ........................................................................................ 22
3.1.10 Therapy protocols ....................................................................................... 22
3.1.11 Outcome ...................................................................................................... 23
3.2 Statistical evaluations of simple correlations by contingency tables ....................... 26
3.2.1 Outcome ........................................................................................................ 26
3.2.2 Eosinophilic counts, its characteristics and correlations .............................. 42
3.3 Statistical analysis of complex correlations by Generalized Linear Model .............. 44
4 DISCUSSION ........................................................................................................................... 47
4.1 Characteristics of study population .......................................................................... 47
4.1.1 Stage of disease ............................................................................................. 48
4.1.2 Localisation.................................................................................................... 48
4.1.3 CNS involvement & BM involvement ............................................................ 49
4.1.4 HIV ................................................................................................................. 50
4.1.5 Anaemia ........................................................................................................ 51
4.1.6 Parasites, Malaria .......................................................................................... 51
4.1.7 Therapy outcome .......................................................................................... 52
4.1.8 Differential white blood cell count ............................................................... 57
4.2 Prognostic factors and correlations .......................................................................... 60
4.2.1 Stage .............................................................................................................. 60
4.2.2 Localisation.................................................................................................... 61
4.2.3 CNS involvement ........................................................................................... 62
4.2.4 Bone marrow involvement ........................................................................... 63
4.2.5 Age................................................................................................................. 63
4.2.6 Sex ................................................................................................................. 64
4.2.7 Therapy protocol ........................................................................................... 64
4.2.8 Blood counts ................................................................................................. 65
4.3 Confounding parameters affecting eosinophilia ...................................................... 68
4.3.1 Stage .............................................................................................................. 68
4.3.2 Localisation.................................................................................................... 68
4.3.3 Parasitic infections ........................................................................................ 68
4.3.4 CNS manifestation ......................................................................................... 69
4.4 Independent prognostic variables in paediatric eBL in Malawi ............................... 69
5 SUMMARY .............................................................................................................................. 71
6 INDEX ..................................................................................................................................... 73
6.1 Abbreviations & Units ............................................................................................... 73
6.2 Tables ........................................................................................................................ 74
6.3 Diagrams ................................................................................................................... 75
7 REFERENCES ........................................................................................................................... 76
8 ACKNOWLEDGEMENTS .......................................................................................................... 89
9 CURRICULUM VITAE .............................................................................................................. 90