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Evens AM , Danilov A , Jagadeesh D , Sperling A , Kim SH , Vaca R , Wei C , Rector D , Sundaram S , Reddy N , Lin Y , Farooq U , D'Angelo C , Bond DA , Berg S , Churnetski MC , Godara A , Khan N , Choi YK , Yazdy M , Rabinovich E , Varma G , Karmali R , Mian A , Savani M , Burkart M , Martin P , Ren A , Chauhan A , Diefenbach C , Straker-Edwards A , Klein AK , Blum KA , Boughan KM , Smith SE , Haverkos BM , Orellana-Noia VM , Kenkre VP , Zayac A , Ramdial J , Maliske SM , Epperla N , Venugopal P , Feldman TA , Smith SD , Stadnik A , David KA , Naik S , Lossos IS , Lunning MA , Caimi P , Kamdar M , Palmisiano N , Bachanova V , Portell CA , Phillips T , Olszewski AJ , Alderuccio JP
Burkitt lymphoma in the modern era: real-world outcomes and prognostication across 30 US cancer centers
Blood. 2021 Jan;137(3) :374-386
AbstractWe 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 induded 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 > 3x 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.
NotesEvens, 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 Kamdar, Manali/AAI-9899-2021 Evens, Andrew/0000-0002-6900-1824; Farooq, Umar/0000-0001-7891-9891; Berg, Stephanie/0000-0001-6193-5350; Savani, Malvi/0000-0002-6059-1389; Diefenbach, Catherine/0000-0003-1116-3246 1528-0020