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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    PMCID: PMC8341354    URL: https://www.ncbi.nlm.nih.gov/pubmed/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
Alderuccio, Juan Pablo Olszewski, Adam J Evens, Andrew M Collins, Graham P Danilov, Alexey V Bower, Mark Jagadeesh, Deepa Zhu, Catherine Sperling, Amy Kim, Seo-Hyun Vaca, Ryan Wei, Catherine Sundaram, Suchitra Reddy, Nishitha Dalla Pria, Alessia D'Angelo, Christopher Farooq, Umar Bond, David A Berg, Stephanie Churnetski, Michael C Godara, Amandeep Khan, Nadia Choi, Yun Kyong Kassam, Shireen Yazdy, Maryam Rabinovich, Emma Post, Frank A Varma, Gaurav Karmali, Reem Burkart, Madelyn Martin, Peter Ren, Albert Chauhan, Ayushi Diefenbach, Catherine Straker-Edwards, Allandria Klein, Andreas Blum, Kristie A Boughan, Kirsten Marie Mian, Agrima Haverkos, Bradley M Orellana-Noia, Victor M Kenkre, Vaishalee P Zayac, Adam Maliske, Seth M Epperla, Narendranath Caimi, Paolo Smith, Scott E Kamdar, Manali Venugopal, Parameswaran Feldman, Tatyana A Rector, Daniel Smith, Stephen D Stadnik, Andrzej Portell, Craig A Lin, Yong Naik, Seema Montoto, Silvia Lossos, Izidore S Cwynarski, Kate eng Blood Adv. 2021 Jul 27;5(14):2852-2862. doi: 10.1182/bloodadvances.2021004458.