Burkitt lymphoma in the modern era: real-world outcomes and prognostication across 30 US cancer centers

Abstract

We examined adults with untreated Burkitt lymphoma (BL) from 2009 to 2018 across 30 US cancer centers. Factors associated with progression-free survival (PFS) and overall survival (OS) were evaluated in univariate and multivariate Cox models. Among 641 BL patients, baseline features included the following: median age, 47 years; HIV+, 22%; Eastern Cooperative Oncology Group (ECOG) performance status (PS) 2 to 4, 23%; >1 extranodal site, 43%; advanced stage, 78%; and central nervous system (CNS) involvement, 19%. Treatment-related mortality was 10%, with most common causes being sepsis, gastrointestinal bleed/perforation, and respiratory failure. With 45-month median follow-up, 3-year PFS and OS rates were 64% and 70%, respectively, without differences by HIV status. Survival was better for patients who received rituximab vs not (3-year PFS, 67% vs 38%; OS, 72% vs 44%; P < .001) and without difference based on setting of administration (ie, inpatient vs outpatient). Outcomes were also improved at an academic vs community cancer center (3-year PFS, 67% vs 46%, P = .006; OS, 72% vs 53%, P = .01). In multivariate models, age ≥ 40 years (PFS, hazard ratio [HR] = 1.70, P = .001; OS, HR = 2.09, P < .001), ECOG PS 2 to 4 (PFS, HR = 1.60, P < .001; OS, HR = 1.74, P = .003), lactate dehydrogenase > 3× normal (PFS, HR = 1.83, P < .001; OS, HR = 1.63, P = .009), and CNS involvement (PFS, HR = 1.52, P = .017; OS, HR = 1.67, P = .014) predicted inferior survival. Furthermore, survival varied based on number of factors present (0, 1, 2 to 4 factors) yielding 3-year PFS rates of 91%, 73%, and 50%, respectively; and 3-year OS rates of 95%, 77%, and 56%, respectively. Collectively, outcomes for adult BL in this real-world analysis appeared more modest compared with results of clinical trials and smaller series. In addition, clinical prognostic factors at diagnosis identified patients with divergent survival rates.

Burkitt Lymphoma Incidence in Five Continents

“…prognostic indices? [114][115][116] has been conducted in richer countries. The exclusion of poorer countries from BL research is ironic given that Denis Burkitt's epoch-making report was based on cases seen in Africa [12].…”

Hypoalbuminemia predicts inferior outcome in patients with AIDS-related lymphoma

“…We also uncovered a strong relationship between hypoalbuminemia and poor ECOG PS as well as higher IPI score. As reported, IPI score and ECOG PS at diagnosis had been identified as independent risk factors for survival in ARL population and in HIV-negative lymphoma patients [ 9 , 15 , 26 , 27 ]. These associations with adverse prognostic factors translated into shorter OS for ARL patients with hypoalbuminemia.…”

Superior outcomes with paediatric protocols in adolescents and young adults with aggressive B‐cell non‐Hodgkin lymphoma

“…33 While adult BL regimens are more intensive, they are generally less intense than paediatric protocols, as measured by dose intensity. 19,33,35 To date, no trials have directly compared these approaches in an AYA population, despite recent calls to do so. 33 Table I Several reasons for the disparity in outcomes according to centre are plausible.…”

“…In contrast, adult regimens for DLBCL comprise less intensive regimens that nonetheless expose AYA to higher cumulative chemotherapy doses and often incorporate radiation 33 . While adult BL regimens are more intensive, they are generally less intense than paediatric protocols, as measured by dose intensity 19,33,35 . To date, no trials have directly compared these approaches in an AYA population, despite recent calls to do so 33 …”