Cancer Research Journal 2019; 7(1): 25-32 http://www.sciencepublishinggroup.com/j/crj doi: 10.11648/j.crj.20190701.14 ISSN: 2330-8192 (Print); ISSN: 2330-8214 (Online) Effect of Second Cycle Pre-induction Chemotherapy in Critically Ill Burkitt’s Lymphoma Children Emad Moussa 1, 2 , Asmaa Hamoda 2, 3 , Samah Semary 2, 4 , Marwa Romeih 5, 6 , Randa Amin 7, 8 , Omneya Hassanin 9 1 Department of Clinical Oncology, Menufiya University, Shebeen, Egypt 2 Department of Pediatric Oncology, Children Cancer Hospital Egypt, Cairo, Egypt 3 Department of Pediatric Oncology, National Cancer Institute, Cairo University, Cairo, Egypt 4 Department of Clinical Oncology, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt 5 Department of Radiodiagnosis, Faculty of Medicine, Helwan University, Helwan, Egypt 6 Department of Radiodiagnosis, Children Cancer Hospital Egypt, Cairo, Egypt 7 Department of Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt 8 Department of Pathology, Children Cancer Hospital Egypt, Cairo, Egypt 9 Department of Clinical Research, Children Cancer Hospital Egypt, Cairo, Egypt Email address: To cite this article: Emad Moussa, Asmaa Hamoda, Samah Semary, Marwa Romeih, Randa Amin, Omneya Hassanin. Effect of Second Cycle Pre-induction Chemotherapy in Critically Ill Burkitt’s Lymphoma Children. Cancer Research Journal. Vol. 7, No. 1, 2019, pp. 25-32. doi: 10.11648/j.crj.20190701.14 Received: February 16, 2019; Accepted: March 25, 2019; Published: April 18, 2019 Abstract: Advanced stage Burkiit’s lymphoma (BL) is associated with tumor burden. Toxicities from intensive therapies are significant. The objectives of this study were to analyze the outcome of patients who could not receive induction chemotherapy on time, and were given a 2 nd pre-phase (CVP), and to measure the impact of delay on disease outcome. It is a retrospective non randomized study included pediatric patients, suffering from Burkitt’s Lymphoma over 8 years period in CCHE. The result showed that, four hundred and eight patients were diagnosed as Burkitt’s Lymphoma from July 2007 till October 2015, 286 patients (70.1%) received induction on time as per protocol, while 122 patients (29.9%) were not fit to receive their induction chemotherapy on due time. The delay ranged from 6-45 days. While forty five patients (36.88%) out of the delayed patients received 2 nd CVP, 16 patients (13.1%) showed relapse/progression. OS among delayed patients who received 2 nd CVP versus those who were delayed and were able to receive full induction chemotherapy was (76.1%), (88.7%) respectively. OS in patients who were delayed versus those who were not delayed was (84%), (85.9%) respectively. In conclusion, in critically ill patients delay of chemotherapy in induction phase is important to reduce morbidity and mortality. The delay of chemotherapy has no impact on OS in Burkitt’s lymphoma children. A second pre-phase therapy in our opinion should not be adopted for all critical ill patients who will not tolerate intensive therapy during early phases of treatment, but instead we recommend a recovery from organ toxicity and starting intensive therapy (COPADM) rather than giving 2 nd CVP with careful surveillance of disease progression. Keywords: Burkitt’s Lymphoma, Second Pre-Induction Phase, Chemotherapy Toxicity 1. Introduction Lymphomas represent more than 15% of malignancies in children and adolescents [1]. Non-Hodgkin’s lymphomas (NHL) in children and adolescents are classified according to the WHO classification based on the immunophenotype and developmental stage of the lymphoid cells. The mature B-cell NHL (Burkitt lymphoma account for about 46% of pediatric NHL, and diffuse large cell B-NHL account for about 8% of pediatric NHL, and high grade B cell lymphoma) represent more than half of pediatric NHL, the other main subtypes are