Burkitt Lymphoma in the Modern Era: Real World Outcomes and Prognostication Across 30 US Cancer Centers. Journal Article

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Authors: Evens, AM; Danilov, AV; Jagadeesh, D; Sperling, AL; Kim, SH; Vaca, RA; Wei, C; Rector, D; Sundaram, S; Reddy, N; Lin, Y; Farooq, U; D'Angelo, C; Bond, D; Berg, S; Churnetski, MC; Godara, A; Khan, N; Choi, YK; Sarraf Yazdy, M; Rabinovich, E; Varma, G; Karmali, R; Mian, A; Savani, M; Burkart, M; Martin, P; Ren, A; Chauhan, A; Diefenbach, CS; Straker-Edwards, A; Klein, A; Blum, K; Boughan, K; Smith, SE; Haverkos, BM; Orellana-Noia, VM; Kenkre, V; Zayac, AS; Ramdial, J; Maliske, S; Epperla, N; Venugopal, P; Feldman, T; Smith, SD; Stadnik, A; David, KA; Naik, S; Lossos, IS; Lunning, M; Caimi, PF; Kamdar, M; Palmisiano, N; Bachanova, V; Portell, CA; Phillips, T; Olszewski, AJ; Alderuccio, JP
Article Title: 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 2009-2018 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: median age 47 years; HIV+ 22%; ECOG performance status (PS) 2-4 in 23%; >1 extranodal site 43%; advanced-stage 78%; and central nervous system (CNS) involvement 19%. Treatment-related mortality (TRM) 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%; P0.001) without difference based on setting of administration (inpatient/outpatient). Outcomes were also improved at an academic vs. community center (3-year PFS 67% vs. 46%, P=0.006; OS 72% vs. 53%, P=0.01). In multivariate models, ages =40 (PFS HR=1.70, P=0.001; OS HR=2.09, P0.001), ECOG PS 2-4 (PFS HR=1.60, P0.001; OS HR=1.74, P=0.003), LDH >3x (PFS HR=1.83, P0.001; OS HR=1.63, P=0.009), and CNS involvement (PFS HR=1.52, P=0.017; OS HR=1.67, P=0.014) predicted inferior survival. Further, survival varied based on number of factors present (0, 1, 2-4 factors): 3-year PFS rates 91%, 73%, 50%, respectively; 3-year OS rates 95%, 77%, 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, prognostic factors at diagnosis identified patients with divergent survival rates.
Journal Title: Blood
ISSN: 1528-0020; 0006-4971
Publisher: American Society of Hematology  
Date Published: 2020