Burkitt lymphoma in the modern era: real-world outcomes and prognostication across 30 US cancer centers.
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Evens Andrew M, Danilov Alexey, Jagadeesh Deepa, Sperling Amy, Kim Seo-Hyun, Vaca Ryan, Wei Catherine, Rector Daniel, Sundaram Suchitra, Reddy Nishitha, Lin Yong, Farooq Umar, D'Angelo Christopher, Bond David A, Berg Stephanie, Churnetski Michael C, Godara Amandeep, Khan Nadia, Choi Yun Kyong, Yazdy Maryam, Rabinovich Emma, Varma Gaurav, Karmali Reem, Mian Agrima, Savani Malvi, Burkart Madelyn, Martin Peter, Ren Albert, Chauhan Ayushi, Diefenbach Catherine, Straker-Edwards Allandria, Klein Andreas K, Blum Kristie A, Boughan Kirsten Marie, Smith Scott E, Haverkos Brad M, Orellana-Noia Victor M, Kenkre Vaishalee P, Zayac Adam, Ramdial Jeremy, Maliske Seth M, Epperla Narendranath, Venugopal Parameswaran, Feldman Tatyana A, Smith Stephen D, Stadnik Andrzej, David Kevin A, Naik Seema, Lossos Izidore S, Lunning Matthew A, Caimi Paolo, Kamdar Manali, Palmisiano Neil, Bachanova Veronika, Portell Craig A, Phillips Tycel, Olszewski Adam J, Alderuccio Juan Pablo
Аннотация
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.