HIV-associated Burkitt lymphoma: outcomes from a US-UK collaborative analysis.
Alderuccio JP., Olszewski AJ., Evens AM., Collins GP., Danilov AV., Bower M., Jagadeesh D., Zhu C., Sperling A., Kim S-H., 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.
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.