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Alderuccio JP , Olszewski AJ , Evens AM , Collins GP , Danilov AV , Bower M , Jagadeesh D , Zhu C , Sperling A , Kim SH , Vaca R , Wei C , Sundaram S , Reddy N , Dalla Pria A , D'Angelo C , Farooq U , Bond DA , Berg S , Churnetski MC , Godara A , Khan N , Choi YK , Kassam S , Yazdy M , Rabinovich E , Post FA , Varma G , Karmali R , Burkart M , Martin P , Ren A , Chauhan A , Diefenbach C , Straker-Edwards A , Klein A , Blum KA , Boughan KM , Mian A , Haverkos BM , Orellana-Noia VM , Kenkre VP , Zayac A , Maliske SM , Epperla N , Caimi P , Smith SE , Kamdar M , Venugopal P , Feldman TA , Rector D , Smith SD , Stadnik A , Portell CA , Lin Y , Naik S , Montoto S , Lossos IS , Cwynarski K
HIV-associated Burkitt lymphoma: outcomes from a US-UK collaborative analysis
Blood Adv. 2021 Jul 27;5(14) :2852-2862
PMID: 34283175   
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Abstract
Data addressing prognostication in patients with HIV related Burkitt lymphoma (HIV-BL) currently treated remain scarce. We present an international analysis of 249 (United States: 140; United Kingdom: 109) patients with HIV-BL treated from 2008 to 2019 aiming to identify prognostic factors and outcomes. With a median follow up of 4.5 years, the 3-year progression-free survival (PFS) and overall survival (OS) were 61% (95% confidence interval [CI] 55% to 67%) and 66% (95%CI 59% to 71%), respectively, with similar results in both countries. Patients with baseline central nervous system (CNS) involvement had shorter 3-year PFS (36%) compared to patients without CNS involvement (69%; P < .001) independent of frontline treatment. The incidence of CNS recurrence at 3 years across all treatments was 11% with a higher incidence observed after dose-adjusted infusional etoposide, doxorubicin, vincristine, prednisone, cyclophosphamide (DA-EPOCH) (subdistribution hazard ratio: 2.52; P = .03 vs other regimens) without difference by CD4 count 100/mm3. In multivariate models, factors independently associated with inferior PFS were Eastern Cooperative Oncology Group (ECOG) performance status 2-4 (hazard ratio [HR] 1.87; P = .007), baseline CNS involvement (HR 1.70; P = .023), lactate dehydrogenase >5 upper limit of normal (HR 2.09; P < .001); and >1 extranodal sites (HR 1.58; P = .043). The same variables were significant in multivariate models for OS. Adjusting for these prognostic factors, treatment with cyclophosphamide, vincristine, doxorubicin, and high-dose methotrexate, ifosfamide, etoposide, and high-dose cytarabine (CODOX-M/IVAC) was associated with longer PFS (adjusted HR [aHR] 0.45; P = .005) and OS (aHR 0.44; P = .007). Remarkably, HIV features no longer influence prognosis in contemporaneously treated HIV-BL.
Notes
2473-9537 Alderuccio, Juan Pablo Orcid: 0000-0002-2690-3377 Olszewski, Adam J Evens, Andrew M Collins, Graham P Danilov, Alexey V Bower, Mark Orcid: 0000-0002-4077-6351 Jagadeesh, Deepa Zhu, Catherine Orcid: 0000-0002-8644-1813 Sperling, Amy Kim, Seo-Hyun Orcid: 0000-0003-1835-2998 Vaca, Ryan Wei, Catherine Sundaram, Suchitra Orcid: 0000-0002-5731-8226 Reddy, Nishitha Dalla Pria, Alessia D'Angelo, Christopher Orcid: 0000-0001-8456-0889 Farooq, Umar Bond, David A Orcid: 0000-0003-0773-1829 Berg, Stephanie Churnetski, Michael C Godara, Amandeep Orcid: 0000-0003-1943-4442 Khan, Nadia Orcid: 0000-0001-8259-4129 Choi, Yun Kyong Kassam, Shireen Yazdy, Maryam Orcid: 0000-0003-2787-3867 Rabinovich, Emma Post, Frank A Orcid: 0000-0002-2844-1612 Varma, Gaurav Orcid: 0000-0002-1903-9170 Karmali, Reem Burkart, Madelyn Orcid: 0000-0002-5105-0564 Martin, Peter Ren, Albert Chauhan, Ayushi Diefenbach, Catherine Orcid: 0000-0003-1116-3246 Straker-Edwards, Allandria Klein, Andreas Blum, Kristie A Boughan, Kirsten Marie Mian, Agrima Orcid: 0000-0001-6992-4883 Haverkos, Bradley M Orcid: 0000-0002-3872-0615 Orellana-Noia, Victor M Kenkre, Vaishalee P Zayac, Adam Orcid: 0000-0002-7591-2069 Maliske, Seth M Orcid: 0000-0003-4774-806x Epperla, Narendranath Orcid: 0000-0002-8216-3457 Caimi, Paolo Smith, Scott E Kamdar, Manali Venugopal, Parameswaran Feldman, Tatyana A Rector, Daniel Smith, Stephen D Orcid: 0000-0001-5354-7593 Stadnik, Andrzej Portell, Craig A Lin, Yong Naik, Seema Orcid: 0000-0002-9859-151x Montoto, Silvia Lossos, Izidore S Orcid: 0000-0002-9346-9013 Cwynarski, Kate Journal Article United States Blood Adv. 2021 Jul 27;5(14):2852-2862. doi: 10.1182/bloodadvances.2021004458.