HIV-associated Burkitt lymphoma: outcomes from a US-UK collaborative analysis

• Type of Material: Article
• Authors: Juan Pablo Alderuccio, University of Miami; Adam J Olszewski, Brown University; Andrew M Evens, Rutgers Cancer Institute of New Jersey; Graham P Collins, Churchill Hospital, Oxford; Alexey Danilov, City of Hope National Medical Center; Mark Bower, Chelsea and Westminster Hospital, London; Deepa Jagadeesh, Cleveland Clinic; Catherine Zhu, University College London Hospital; Amy Sperling, University of Washington; Seo-Hyun Kim, Rush University; Ryan Vaca, Pennsylvania State University; Catherine Wei, Rutgers Cancer Institute of New Jersey; Suchitra Sundaram, Roswell Park Comprehensive Cancer Center; Nishitha Reddy, Vanderbilt University; Alessia Dalla Pria, Chelsea and Westminster Hospital; Christopher D'Angelo, University of Wisconsin, Madison; Umar Farooq, University of Iowa; David A Bond, The Ohio State University Hospital; Stephanie Berg, Loyola University Medical Cente; Micheal C Churnetski, Emory University; Amandeep Godara, Tufts Medical Center; Nadia Khan, Fox Chase Cancer Center; Yun Kyong Choi, New York University (NYU); Shireen Kassam, King’s College Hospital, London; Maryam Yazdy, Georgetown University Hospital; Emma Rabinovich, University of Illinois at Chicago; Frank A Post, King’s College Hospital London; Gaurav Varma, New York-Presbyterian Hospital; Reem Karmali, Northwestern University; Madelyn Burkart, Northwestern University; Peter Martin, New York Presbyterian Hosp; Albert Ren, University of Illinois at Chicago; Ayushu Chauhan, Georgetown University Hospital; Catherine Diefenbach, New York University (NYU); Allandria Straker-Edwards, Fox Chase Cancer Center; Andreas Klein, Tufts Medical Center; Kristie Blum, Emory University; Kirsten Marie Boughan, University Hospitals Seidman Cancer Center; Agrima Mian, Cleveland Clinic; Bradley M Haverkos, University of Colorado, Denver; Victor Orellana-Noia, Emory University; Vaishalee P Kenkre, University of Wisconsin, Madison; Adam Zayac, Brown University; Seth M Maliske, University of Iowa; Narendranath Epperla, The Ohio State University Hospital; Paolo Caimi, University Hospitals Seidman Cancer Center; Scott E Smith, Loyola University Medical Center; Manali Kamdar, University of Colorado, Denver; Parameswaran Venugopal, Rush University; Tatyana A Feldman, Hackensack University Medical Center; Daniel Rector, Hackensack University Medical Center; Stephen D Smith, University of Washington; Andrzej Stadnik, Oregon Health & Science University; Craig A Portell, University of Virginia; Yong Lin, Rutgers Cancer Institute of New Jersey; Seema Naik, Pennsylvania State University; Silvia Montoto, St Bartholomews & Royal London NHS Trust; Izidore S Lossos, University of Miami; Kate Cwynarski, University College London Hospital
• Language: English
• Date: 2021-07-21
• Publisher: ELSEVIER
• Publication Version: Final Published Version
• Copyright Statement: © 2021 by The American Society of Hematology
• Final Published Version (URL): http://dx.doi.org/10.1182/bloodadvances.2021004458
• Title of Journal or Parent Work: BLOOD ADVANCES
• Volume: 5
• Issue: 14
• Start Page: 2852
• End Page: 2862
• Keywords: CHEMOTHERAPY; CODOX-M/IVAC; DOXORUBICIN; RITUXIMAB; Life Sciences & Biomedicine; SAFE; SURVIVAL; B-CELL LYMPHOMA; ACTIVE ANTIRETROVIRAL THERAPY; Hematology; ADULTS; Science & Technology; ERA
• Research Categories: Health Sciences, Oncology

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.