Dynamic Metabolic Parameters and Deauville Score on 18F-FDG PET/CT for Prognostic Assessment in Pediatric Burkitt Lymphoma

Background/Objectives: 18F-FDG PET/CT is increasingly used in pediatric Burkitt lymphoma (BL) for staging and treatment response assessment, but data on quantitative prognostic markers remain limited. Methods: We retrospectively evaluated 33 children with pathologically confirmed BL who underwent baseline and end-of-treatment (EOT) 18F-FDG PET/CT between 2009 and 2025. SUVmax, metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were measured at baseline and EOT, and the Deauville score (DS) was assigned visually. Progression-free survival (PFS) and overall survival (OS) were estimated with the Kaplan–Meier method; receiver operating characteristic (ROC) analysis identified predictive thresholds. Results: Three-year and 5-year OS was 89.6%, and PFS was 90.1%. The percentage reduction in SUVmax from baseline to EOT (%ΔSUVmax) was the strongest predictor of survival (AUC = 0.94; optimal cutoff ≥ 73.6% reduction; sensitivity 100%, specificity 93%). Patients with an unfavorable EOT DS (4–5) had significantly lower OS than those with a favorable DS (1–3) (60.0% vs. 96.4%; log-rank p = 0.009). Baseline SUVmax, MTV, and TLG did not differ significantly by stage or splenic involvement. Given the small number of survival events (n = 3), the corresponding hazard ratios and confidence intervals should be regarded as exploratory and hypothesis-generating rather than definitive effect sizes. Conclusions: Dynamic metabolic response such as %ΔSUVmax and the EOT Deauville score are promising prognostic markers in pediatric BL. Given the small number of events, these findings warrant validation in larger, prospective cohorts.