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HIV-associated Burkitt lymphoma: outcomes from a US-UK collaborative analysis
Juan Pablo Alderuccio1, Adam J Olszewski2, Andrew M Evens3
1Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, FL.
Blood Advances
|July 20, 2021
Summary
Prognostic factors for HIV-related Burkitt lymphoma (HIV-BL) were identified in a large international study. CODOX-M/IVAC chemotherapy improved outcomes, and HIV status did not impact prognosis in modern treatments.
Area of Science:
- Oncology
- Infectious Diseases
- Clinical Research
Background:
- Prognostic data for patients with HIV-related Burkitt lymphoma (HIV-BL) undergoing contemporary treatment is limited.
- Understanding prognostic factors is crucial for optimizing treatment strategies and improving patient outcomes in HIV-BL.
Purpose of the Study:
- To identify prognostic factors and evaluate outcomes in a large international cohort of HIV-BL patients treated between 2008 and 2019.
- To assess the impact of different chemotherapy regimens on progression-free survival (PFS) and overall survival (OS) in HIV-BL.
Main Methods:
- International analysis of 249 HIV-BL patients treated from 2008 to 2019.
- Multivariate models were used to identify independent prognostic factors for PFS and OS.
- Comparison of outcomes between different chemotherapy regimens, including dose-adjusted infusional etoposide, doxorubicin, vincristine, prednisone, cyclophosphamide (DA-EPOCH) and cyclophosphamide, vincristine, doxorubicin, and high-dose methotrexate, ifosfamide, etoposide, and high-dose cytarabine (CODOX-M/IVAC).
Main Results:
- The 3-year PFS and OS were 61% and 66%, respectively.
- Independent adverse prognostic factors included ECOG performance status 2-4, baseline central nervous system (CNS) involvement, lactate dehydrogenase >5x upper limit of normal, and >1 extranodal sites.
- CODOX-M/IVAC chemotherapy was associated with significantly longer PFS and OS compared to other regimens, independent of prognostic factors.
- Higher incidence of CNS recurrence was observed with DA-EPOCH compared to other regimens.
- HIV status did not significantly influence prognosis in contemporaneously treated HIV-BL patients.
Conclusions:
- Key prognostic factors for HIV-BL include performance status, CNS involvement, LDH levels, and number of extranodal sites.
- CODOX-M/IVAC chemotherapy demonstrates superior efficacy in improving PFS and OS for HIV-BL patients.
- Contemporary treatment strategies have diminished the impact of HIV status on prognosis for HIV-BL.
