Restaging Pediatric Patients Diagnosed with Burkitt Lymphoma using the International Pediatric Non-Hodgkin Lymphoma Staging System and Applying its new Response Criteria

Background: Burkitt lymphoma is the most common mature B-cell lymphoma in children. Accurate staging is essential for risk stratification, treatment planning, and predicting outcomes. The International Pediatric Non-Hodgkin Lymphoma Staging System provides a more detailed assessment compared with the St. Jude/Murphy system.This retrospective study aimed to restage newly diagnosed pediatric BL patients using IPNHLSS and to assess its prognostic value in predicting survival outcomes in a single-institution cohort study. Methods: the study included 100 pediatric BL patients treated according to LMB 96 protocol between 2018 and 2023. All patients were staged using both the St. Jude/Murphy system and IPNHLSS. Clinical characteristics, treatment response, and outcomes were analyzed, and the prognostic impact of the staging systems was compared. Results: Using the St. Jude/Murphy system, patients were distributed as stage III (91%), and IV (6%). When restaged with IPNHLSS , stage III (74%), and stage IV (23%). At a median follow-up of 25months, the 3-year event-free survival (EFS) and overall survival (OS) were 79.7% and 85.8%, respectively. While EFS , according to staging system , 59.5 % stage IV by IPSS , VS 50 % by Murphy , in comparison to 85 % stage III by IPNHLSS , VS 81.1 % by Murphy , with significant p value (0.01). Conclusion: IPNHLSS provides a more precise evaluation of disease extent in pediatric BL, particularly regarding bone marrow involvement, and demonstrates prognostic relevance.