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

2021; Elsevier BV; Volume: 137; Issue: 3 Linguagem: Inglês

10.1182/blood.2020006926

1528-0020

Andrew M. Evens, Alexey V. Danilov, Deepa Jagadeesh, Amy Sperling, Seo‐Hyun Kim, Ryan Vaca, Catherine Wei, Daniel Rector, Suchitra Sundaram, Nishitha Reddy, Yong Lin, Umar Farooq, Christopher R. D’Angelo, David A. Bond, Stephanie Berg, Michael C. Churnetski, Amandeep Godara, Nadia Khan, Yun Kyong Choi, Maryam Sarraf Yazdy, Emma Rabinovich, Gaurav Varma, Reem Karmali, Agrima Mian, Malvi Savani, Madelyn Burkart, Peter Martin, Albert Ren, Ayushi Chauhan, Catherine Diefenbach, Allandria Straker-Edwards, Andreas K. Klein, Kristie A. Blum, Kirsten M Boughan, Scott E. Smith, Brad M. Haverkos, Victor M. Orellana‐Noia, Vaishalee P. Kenkre, Adam Zayac, Jeremy Ramdial, Seth Maliske, Narendranath Epperla, Parameswaran Venugopal, Tatyana Feldman, Stephen D. Smith, Andrzej Stadnik, Kevin A. David, Seema Naik, Izidore S. Lossos, Matthew A. Lunning, Paolo F. Caimi, Manali Kamdar, Neil Palmisiano, Veronika Bachanová, Craig A. Portell, Tycel Phillips, Adam J. Olszewski, Juan Pablo Alderuccio,

Cancer Genomics and Diagnostics

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.