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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
Burkitt Lymphoma in the Modern Era: Real World Outcomes and Prognostication Across 30 US Cancer Centers
Blood. 2021 Jan 21;137(3) :374-386
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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%; P<0.001) 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, P<0.001), ECOG PS 2-4 (PFS HR=1.60, P<0.001; OS HR=1.74, P=0.003), LDH >3x (PFS HR=1.83, P<0.001; 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.
Notes
1528-0020 Evens, Andrew M Danilov, Alexey V Jagadeesh, Deepa Sperling, Amy Lynn Kim, Seo-Hyun Vaca, Ryan A Wei, Catherine Rector, Daniel Sundaram, Suchitra Reddy, Nishitha Lin, Yong Farooq, Umar D'Angelo, Christopher Bond, David Berg, Stephanie Churnetski, Michael C Godara, Amandeep Khan, Nadia Choi, Yun Kyong Sarraf Yazdy, Maryam Rabinovich, Emma Varma, Gaurav Karmali, Reem Mian, Agrima Savani, Malvi Burkart, Madelyn Martin, Peter Ren, Albert Chauhan, Ayushi Diefenbach, Catherine Sibyl Straker-Edwards, Allandria Klein, Andreas Blum, Kristie Boughan, Kirsten Smith, Scott E Haverkos, Bradley M Orellana-Noia, Victor Manuel Kenkre, Vaishalee Zayac, Adam S Ramdial, Jeremy Maliske, Seth Epperla, Narendranath Venugopal, Parameswaran Feldman, Tatyana Smith, Stephen D Stadnik, Andrzej David, Kevin A Naik, Seema Lossos, Izidore S Lunning, Matthew Caimi, Paolo F Kamdar, Manali Palmisiano, Neil Bachanova, Veronika Portell, Craig A Phillips, Tycel Olszewski, Adam J Alderuccio, Juan Pablo Journal Article United States Blood. 2020 Jul 14:blood.2020006926. doi: 10.1182/blood.2020006926.