Population‐based prognostic factors for survival in patients with Burkitt lymphoma: An analysis from the Surveillance, Epidemiology, and End Results database

Abstract

BACKGROUND: Burkitt lymphoma (BL) is an aggressive but potentially curable lymphoma, previously described in small, singleinstitution studies. This study evaluated prognostic factors for survival in adult patients with BL and a potential outcome improvement over the past decade in a population-based cohort. METHODS: Adult patients with BL diagnosed between 1998 and 2009 were selected from the Surveillance, Epidemiology, and End Results (SEER) database. Prognostic factors were identified in a multivariate model for relative survival (RS), and trends in survival were evaluated using period analysis. RESULTS: The study cohort included 2284 patients, with a median age of 49 years and male predominance (2.6:1). Gastrointestinal tract and the head and neck were the most common sites of extranodal disease. Older age, black race/ethnicity, and advanced stage were associated with a worse survival. In the period analysis, trends in improved survival between 1998 and 2009 were seen, except for patients older than 60 years and black patients, whose survival did not improve. A prognostic score divided patients into 4 groups: low-risk (5-year RS: 71%), lowintermediate (5-year RS: 55%), high-intermediate (5-year RS: 41%), and high-risk (5-year RS: 29%; P <.001). CONCLUSIONS: The outcome of patients younger than 60 years with BL improved over the past decade. Age, race, and stage have a prognostic role for survival. The proposed score can help inform prognosis in newly diagnosed patients and stratify participants in future trials. Cancer 2013;119:3672-9. V C 2013 American Cancer Society.KEYWORDS: Burkitt lymphoma; prognostic factors; SEER; epidemiology; race; rituximab. INTRODUCTIONBurkitt lymphoma (BL) is a highly aggressive but also curable subtype of non-Hodgkin lymphoma (NHL). BL is characterized by a translocation involving the MYC oncogene located in chromosome 8 and genes associated with transcription of immunoglobulin heavy and light chains. 1 Such translocations in the MYC oncogene promote cell cycle deregulation characterized by increased proliferation rates close to 100% in pathological samples.The treatment of BL usually requires intensive multiagent chemotherapeutic regimens with central nervous system penetrance. [2][3][4] Many of the protocols were adapted for adults based on the improved outcomes seen in pediatric patients. 5,6 With the addition of rituximab to chemotherapy, an improvement in response and survival rates in patients with BL is expected, although it had been difficult to conclusively demonstrate in small single-arm, single-institution studies. 7,8 In addition, little is known about prognostic factors for survival in patients with BL in the rituximab era, which makes patient counseling and stratification in contemporary treatment studies difficult. Current guidelines are limited to recommending uniform, aggressive therapy for all patients without risk categorization based on stage or other validated factors.The aims of this study were to identify population-based prognostic factors for survival in ...

Rituximab is associated with improved survival in Burkitt lymphoma: a retrospective analysis from two US academic medical centers

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