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Relapse Patterns in Burkitt's Lymphoma¹

Lymphoma Treatment Center, Department of Surgery, Makerere University Medical School, Kampala, Uganda

The clinical course of 130 patients with Burkitt's lymphoma was reviewed. Death occurred soon after treatment in 18 (14%), and failure to respond to chemotherapy was observed in 5 (4%). One hundred seven patients achieved complete remissions, among whom 84 were followed for at least 1 year, or until relapse. Tumor relapse was observed to be of two distinct types. Early relapse was characterized by recurrent tumor growth in the same site as the original tumor and occurred within 10 weeks of initial therapy. Patients with early relapse tended to have generalized disease on admission, responded poorly to subsequent treatment, and had a poor prognosis. Late relapse occurred beyond the 10-week interval from initial therapy and usually appeared in previously uninvolved anatomical sites. Responses to subsequent chemotherapy were excellent, and the prognosis was good. The pattern of relapse appeared to be independent of the aggressiveness of the initial chemotherapeutic regime. Drug resistance, immunoresistance, and/or host immune failure are postulated to explain the emergence of early relapse. Although immunological mechanisms may be operative in the pathogenesis of late relapse, reinduction of tumor remains a possibility.

¹ Supported by Contract PH 43-67-1343 from the National Cancer Institute, Bethesda, Md.

² Director, Uganda Cancer Institute, Department of Surgery, Makerere University Medical School, Kampala, Uganda (Senior Investigator, Medicine Branch, National Cancer Institute, Bethesda, Md.).

³ Formerly Director, Lymphoma Treatment Center. Present address: Department of Medicine, Columbia College of Physicians and Surgeons, New York, N. Y.

⁴ Formerly Scientific Advisor, Lymphoma Treatment Center. Present address: Department of Medicine, University of Washington, Seattle, Wash.

⁵ Formerly Senior Lecturer, Department of Preventive Medicine, Makerere University Medical School, Kampala, Uganda. Present address: Harvard School of Public Health, Boston, Mass.

Received 11/30/71. Accepted 3/ 7/72.