HIV-associated Burkitt lymphoma: outcomes from a US-UK collaborative analysis

Abstract

Data addressing prognostication in patients with HIV related Burkitt lymphoma (HIV-BL) currently treated remain scarce. We present an international analysis of 249 (United States: 140; United Kingdom: 109) patients with HIV-BL treated from 2008 to 2019 aiming to identify prognostic factors and outcomes. With a median follow up of 4.5 years, the 3-year progression-free survival (PFS) and overall survival (OS) were 61% (95% confidence interval [CI] 55% to 67%) and 66% (95%CI 59% to 71%), respectively, with similar results in both countries. Patients with baseline central nervous system (CNS) involvement had shorter 3-year PFS (36%) compared to patients without CNS involvement (69%; P < .001) independent of frontline treatment. The incidence of CNS recurrence at 3 years across all treatments was 11% with a higher incidence observed after dose-adjusted infusional etoposide, doxorubicin, vincristine, prednisone, cyclophosphamide (DA-EPOCH) (subdistribution hazard ratio: 2.52; P = .03 vs other regimens) without difference by CD4 count 100/mm3. In multivariate models, factors independently associated with inferior PFS were Eastern Cooperative Oncology Group (ECOG) performance status 2-4 (hazard ratio [HR] 1.87; P = .007), baseline CNS involvement (HR 1.70; P = .023), lactate dehydrogenase >5 upper limit of normal (HR 2.09; P < .001); and >1 extranodal sites (HR 1.58; P = .043). The same variables were significant in multivariate models for OS. Adjusting for these prognostic factors, treatment with cyclophosphamide, vincristine, doxorubicin, and high-dose methotrexate, ifosfamide, etoposide, and high-dose cytarabine (CODOX-M/IVAC) was associated with longer PFS (adjusted HR [aHR] 0.45; P = .005) and OS (aHR 0.44; P = .007). Remarkably, HIV features no longer influence prognosis in contemporaneously treated HIV-BL.

Comparative outcomes for mature T-cell and NK/T-cell lymphomas in people with and without HIV and to AIDS-defining lymphomas

“… 19,20 In a recent retrospective multicenter international analysis of 249 patients with newly diagnosed HIV-Burkitt lymphoma (BL), contemporaneously treated in the United States and United Kingdom, no HIV-related factors influenced survival outcomes that correlated with prior reports in this subtype. 21,22 Similar observations have been reported for other HIV-associated lymphomas such as diffuse large B-cell lymphoma (DLBCL), Hodgkin’s lymphoma (HL), and primary central nervous system lymphoma (PCNSL). 23-25 There have been no comparative studies evaluating prognostic factors and outcomes of TCL and NK/TCL in people with and without HIV (PWoH).…”

Progress in the Treatment of HIV-Associated Lymphoma When Combined With the Antiretroviral Therapies

“…Compared to chemotherapy alone, the addition of rituximab to the treatment of BL patients improved the 3 year PFS (67% vs. 38%, p<0.001) and OS (72% vs. 44%, p<0.001). A detailed analysis of HIV-BL in this BL cohort was reported by Alderuccio JP et al (37). separately.…”

The EHA Research Roadmap: Malignant Lymphoid Diseases

“…The most frequent schedules used for DLBCL are R-CHOP, and R-EPOCH (rituximab, etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin); for BL the most frequent schedules are RCODOX-M/IVAC (rituximab, cyclophosphamide, vincristine, doxorubicin, and methotrexate/ifosfamide, etoposide, and cytarabine), LMB, NHL2002, Burkimab, and dose-adjusted R-EPOCH, among others. 162 A new prognostic score for HIV-related lymphomas in the rituximab era (AIDS-Related Lymphoma International Prognostic Index) has been developed with important participation of European groups. Similarly, an international effort has been made to define the prognostic factors of HL patients treated with ABVD and cART.…”