Burkitt lymphoma in the modern era: Real-world outcomes and prognostication across 30 US cancer centers

Andrew M. Evens; Alexey Danilov; Deepa Jagadeesh; Amy Sperling; Seo Hyun Kim; Ryan Vaca; Catherine Wei; Daniel Rector; Suchitra Sundaram; Nishitha Reddy; Yong Lin; Umar Farooq; Christopher D'Angelo; David A. Bond; Stephanie Berg; Michael C. Churnetski; Amandeep Godara; Nadia Khan; Yun Kyong Choi; Maryam Yazdy; Emma Rabinovich; Gaurav Varma; Reem Karmali; Agrima Mian; Malvi Savani; Madelyn Burkart; Peter Martin; Albert Ren; Ayushi Chauhan; Catherine Diefenbach; Allandria Straker-Edwards; Andreas K. Klein; Kristie A. Blum; Kirsten Marie Boughan; Scott E. Smith; Brad M. Haverkos; Victor M. Orellana-Noia; Vaishalee P. Kenkre; Adam Zayac; Jeremy Ramdial; Seth M. Maliske; Narendranath Epperla; Parameswaran Venugopal; Tatyana A. Feldman; Stephen D. Smith; Andrzej Stadnik; Kevin A. David; Seema Naik; Izidore S. Lossos; Matthew A. Lunning; Paolo Caimi; Manali Kamdar; Neil Palmisiano; Veronika Bachanova; Craig A. Portell; Tycel Phillips; Adam J. Olszewski; Juan Pablo Alderuccio

doi:10.1182/blood.2020006926

Burkitt lymphoma in the modern era: Real-world outcomes and prognostication across 30 US cancer centers

Andrew M. Evens, Alexey Danilov, Deepa Jagadeesh, Amy Sperling, Seo Hyun Kim, Ryan Vaca, Catherine Wei, Daniel Rector, Suchitra Sundaram, Nishitha Reddy, Yong Lin, Umar Farooq, Christopher D'Angelo, David A. Bond, Stephanie Berg, Michael C. Churnetski, Amandeep Godara, Nadia Khan, Yun Kyong Choi, Maryam YazdyEmma Rabinovich, Gaurav Varma, Reem Karmali, Agrima Mian, Malvi Savani, Madelyn Burkart, Peter Martin, Albert Ren, Ayushi Chauhan, Catherine Diefenbach, Allandria Straker-Edwards, Andreas K. Klein, Kristie A. Blum, Kirsten Marie Boughan, Scott E. Smith, Brad M. Haverkos, Victor M. Orellana-Noia, Vaishalee P. Kenkre, Adam Zayac, Jeremy Ramdial, Seth M. Maliske, Narendranath Epperla, Parameswaran Venugopal, Tatyana A. Feldman, Stephen D. Smith, Andrzej Stadnik, Kevin A. David, Seema Naik, Izidore S. Lossos, Matthew A. Lunning, Paolo Caimi, Manali Kamdar, Neil Palmisiano, Veronika Bachanova, Craig A. Portell, Tycel Phillips, Adam J. Olszewski, Juan Pablo Alderuccio

Research output: Contribution to journal › Article › peer-review

58 Scopus citations

Abstract

We examined adults with untreated Burkitt lymphoma (BL) from 2009 to 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 the following: median age, 47 years; HIV+, 22%; Eastern Cooperative Oncology Group (ECOG) performance status (PS) 2 to 4, 23%; >1 extranodal site, 43%; advanced stage, 78%; and central nervous system (CNS) involvement, 19%. Treatment-related mortality 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 < .001) and without difference based on setting of administration (ie, inpatient vs outpatient). Outcomes were also improved at an academic vs community cancer center (3-year PFS, 67% vs 46%, P = .006; OS, 72% vs 53%, P = .01). In multivariate models, age ≥ 40 years (PFS, hazard ratio [HR] = 1.70, P = .001; OS, HR = 2.09, P < .001), ECOG PS 2 to 4 (PFS, HR = 1.60, P < .001; OS, HR = 1.74, P = .003), lactate dehydrogenase > 3× normal (PFS, HR = 1.83, P < .001; OS, HR = 1.63, P = .009), and CNS involvement (PFS, HR = 1.52, P = .017; OS, HR = 1.67, P = .014) predicted inferior survival. Furthermore, survival varied based on number of factors present (0, 1, 2 to 4 factors) yielding 3-year PFS rates of 91%, 73%, and 50%, respectively; and 3-year OS rates of 95%, 77%, and 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, clinical prognostic factors at diagnosis identified patients with divergent survival rates.

Original language	English (US)
Pages (from-to)	374-386
Number of pages	13
Journal	Blood
Volume	137
Issue number	3
DOIs	https://doi.org/10.1182/blood.2020006926
State	Published - Jan 21 2021

Bibliographical note

Funding Information:
from Kite Pharma. N.E. is on the speaker’s bureau for Verastem Oncology and received honoraria from Pharmacyclics. N.K. has membership on an entity’s board of directors or advisory committee for Seattle Genetics and Abbvie; provides educational content/symposium for Janssen; and receives research funds from Bristol Myers. J.A. is an immediate family member who received honoraria from Puma Biotechnology, Agios, Inovio Pharmaceuticals, and Foundation Medicine; receives honoraria from Targeted Oncology; and consults for OncLive. M.Y. receives honoraria from Bayer; receives research funding from Genentech; and consults for Octapharma and Abbvie. C.D. consults for and received research funding from Bristol-Myers Squibb; receives research funding from Denovo; consults for and receives research funding from Gen-entech; receives research funding from Incyte, LAM Therapeutics, MEI, Millenium/Takeda, and Trillium; consults for and receives research funding from Merck; and consults for and receives research funding from Seattle Genetics. R.K. is on the speakers bureau for Astrazeneca; receives institutional research funding from Takeda and BMS; and consults for and is on the speakers bureau for Gilead, Kite, Juno, and Celgene. P.M. consults foe Celgene, Teneobio, Karyopharm, Janssen, Sandoz, and I-MAB. M.K. is on the speakers bureau for Seattle Genetics; consults for Pharmacyclics, AstraZeneca, and Celgene; and is employed by the University of Colorado. C.P. receives research funding from Xencor, Roche/Genentech, Infinity, TG Therapeutics, AbbVie, and Acerta/ AstraZeneca; consults for Pharmacyclics, Janssen, Amgen, and Bayer; and consults for and received research funding from Genentech, Bei-Gene, and Kite. I.L. has membership on an entity’s board of directors or advisory committee for Janssen Scientific and Seattle Genetics and receives research funding from the National Institutes of Health. A.O. receives research funding from Genentech, Adaptive Biotechnologies, TG Therapeutics, and Spectrum Pharmaceuticals. The remaining authors declare no competing financial interests.

Funding Information:
Conflict-of-interest disclosure: A.E. consulted for and received honoraria from Seattle Genetics; received honoraria from Research to Practice; consulted for and received honoraria from Epizyme; consulted for and received honoraria from Verastem; consulted for and received honoraria from MorphoSys; consulted for and received honoraria from Affimed; received honoraria from Novartis and Pharmacyclics for Data Safety Monitoring Committee services; consulted for and received honoraria from Bayer; and received research funding from Takeda and Merck. S.S. received research funding from Incyte Corporation, Seattle Genetics, Portola Pharmaceuticals, Pharmacyclics, Acerta Pharma BV, AstraZeneca, Genentech, and Denova Biopharma; received membership on the board of directors or advisory committee for AstraZeneca; consulted for and received research funding from Merck Sharp & Dohme Corp.; and his spouse received researching funding from Ignyta, Bristol-Myers Squibb, and Ayala. S.N. was on the advisory board for Celgene. N.R. consulted for KITE Pharma, Abbvie, and Celgene, received research funding from Genentech; and consulted for and received research funding from BMS. U.F. received honoraria from Celgene and received research funding

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© 2021 by The American Society of Hematology.

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Evens, A. M., Danilov, A., Jagadeesh, D., Sperling, A., Kim, S. H., Vaca, R., Wei, C., Rector, D., Sundaram, S., Reddy, N., Lin, Y., Farooq, U., D'Angelo, C., Bond, D. A., Berg, S., Churnetski, M. C., Godara, A., Khan, N., Choi, Y. K., ... Alderuccio, J. P. (2021). Burkitt lymphoma in the modern era: Real-world outcomes and prognostication across 30 US cancer centers. Blood, 137(3), 374-386. https://doi.org/10.1182/blood.2020006926

Evens, AM, Danilov, A, Jagadeesh, D, Sperling, A, Kim, SH, Vaca, R, Wei, C, Rector, D, Sundaram, S, Reddy, N, Lin, Y, Farooq, U, D'Angelo, C, Bond, DA, Berg, S, Churnetski, MC, Godara, A, Khan, N, Choi, YK, Yazdy, M, Rabinovich, E, Varma, G, Karmali, R, Mian, A, Savani, M, Burkart, M, Martin, P, Ren, A, Chauhan, A, Diefenbach, C, Straker-Edwards, A, Klein, AK, Blum, KA, Boughan, KM, Smith, SE, Haverkos, BM, Orellana-Noia, VM, Kenkre, VP, Zayac, A, Ramdial, J, Maliske, SM, Epperla, N, Venugopal, P, Feldman, TA, Smith, SD, Stadnik, A, David, KA, Naik, S, Lossos, IS, Lunning, MA, Caimi, P, Kamdar, M, Palmisiano, N, Bachanova, V, Portell, CA, Phillips, T, Olszewski, AJ & Alderuccio, JP 2021, 'Burkitt lymphoma in the modern era: Real-world outcomes and prognostication across 30 US cancer centers', Blood, vol. 137, no. 3, pp. 374-386. https://doi.org/10.1182/blood.2020006926

@article{6be99b8a3f294b94956a383d14f0f2ea,

title = "Burkitt lymphoma in the modern era: Real-world outcomes and prognostication across 30 US cancer centers",

abstract = "We examined adults with untreated Burkitt lymphoma (BL) from 2009 to 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 the following: median age, 47 years; HIV+, 22%; Eastern Cooperative Oncology Group (ECOG) performance status (PS) 2 to 4, 23%; >1 extranodal site, 43%; advanced stage, 78%; and central nervous system (CNS) involvement, 19%. Treatment-related mortality 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 < .001) and without difference based on setting of administration (ie, inpatient vs outpatient). Outcomes were also improved at an academic vs community cancer center (3-year PFS, 67% vs 46%, P = .006; OS, 72% vs 53%, P = .01). In multivariate models, age ≥ 40 years (PFS, hazard ratio [HR] = 1.70, P = .001; OS, HR = 2.09, P < .001), ECOG PS 2 to 4 (PFS, HR = 1.60, P < .001; OS, HR = 1.74, P = .003), lactate dehydrogenase > 3× normal (PFS, HR = 1.83, P < .001; OS, HR = 1.63, P = .009), and CNS involvement (PFS, HR = 1.52, P = .017; OS, HR = 1.67, P = .014) predicted inferior survival. Furthermore, survival varied based on number of factors present (0, 1, 2 to 4 factors) yielding 3-year PFS rates of 91%, 73%, and 50%, respectively; and 3-year OS rates of 95%, 77%, and 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, clinical prognostic factors at diagnosis identified patients with divergent survival rates.",

author = "Evens, {Andrew M.} and Alexey Danilov and Deepa Jagadeesh and Amy Sperling and Kim, {Seo Hyun} and Ryan Vaca and Catherine Wei and Daniel Rector and Suchitra Sundaram and Nishitha Reddy and Yong Lin and Umar Farooq and Christopher D'Angelo and Bond, {David A.} and Stephanie Berg and Churnetski, {Michael C.} and Amandeep Godara and Nadia Khan and Choi, {Yun Kyong} and Maryam Yazdy and Emma Rabinovich and Gaurav Varma and Reem Karmali and Agrima Mian and Malvi Savani and Madelyn Burkart and Peter Martin and Albert Ren and Ayushi Chauhan and Catherine Diefenbach and Allandria Straker-Edwards and Klein, {Andreas K.} and Blum, {Kristie A.} and Boughan, {Kirsten Marie} and Smith, {Scott E.} and Haverkos, {Brad M.} and Orellana-Noia, {Victor M.} and Kenkre, {Vaishalee P.} and Adam Zayac and Jeremy Ramdial and Maliske, {Seth M.} and Narendranath Epperla and Parameswaran Venugopal and Feldman, {Tatyana A.} and Smith, {Stephen D.} and Andrzej Stadnik and David, {Kevin A.} and Seema Naik and Lossos, {Izidore S.} and Lunning, {Matthew A.} and Paolo Caimi and Manali Kamdar and Neil Palmisiano and Veronika Bachanova and Portell, {Craig A.} and Tycel Phillips and Olszewski, {Adam J.} and Alderuccio, {Juan Pablo}",

note = "Funding Information: from Kite Pharma. N.E. is on the speaker{\textquoteright}s bureau for Verastem Oncology and received honoraria from Pharmacyclics. N.K. has membership on an entity{\textquoteright}s board of directors or advisory committee for Seattle Genetics and Abbvie; provides educational content/symposium for Janssen; and receives research funds from Bristol Myers. J.A. is an immediate family member who received honoraria from Puma Biotechnology, Agios, Inovio Pharmaceuticals, and Foundation Medicine; receives honoraria from Targeted Oncology; and consults for OncLive. M.Y. receives honoraria from Bayer; receives research funding from Genentech; and consults for Octapharma and Abbvie. C.D. consults for and received research funding from Bristol-Myers Squibb; receives research funding from Denovo; consults for and receives research funding from Gen-entech; receives research funding from Incyte, LAM Therapeutics, MEI, Millenium/Takeda, and Trillium; consults for and receives research funding from Merck; and consults for and receives research funding from Seattle Genetics. R.K. is on the speakers bureau for Astrazeneca; receives institutional research funding from Takeda and BMS; and consults for and is on the speakers bureau for Gilead, Kite, Juno, and Celgene. P.M. consults foe Celgene, Teneobio, Karyopharm, Janssen, Sandoz, and I-MAB. M.K. is on the speakers bureau for Seattle Genetics; consults for Pharmacyclics, AstraZeneca, and Celgene; and is employed by the University of Colorado. C.P. receives research funding from Xencor, Roche/Genentech, Infinity, TG Therapeutics, AbbVie, and Acerta/ AstraZeneca; consults for Pharmacyclics, Janssen, Amgen, and Bayer; and consults for and received research funding from Genentech, Bei-Gene, and Kite. I.L. has membership on an entity{\textquoteright}s board of directors or advisory committee for Janssen Scientific and Seattle Genetics and receives research funding from the National Institutes of Health. A.O. receives research funding from Genentech, Adaptive Biotechnologies, TG Therapeutics, and Spectrum Pharmaceuticals. The remaining authors declare no competing financial interests. Funding Information: Conflict-of-interest disclosure: A.E. consulted for and received honoraria from Seattle Genetics; received honoraria from Research to Practice; consulted for and received honoraria from Epizyme; consulted for and received honoraria from Verastem; consulted for and received honoraria from MorphoSys; consulted for and received honoraria from Affimed; received honoraria from Novartis and Pharmacyclics for Data Safety Monitoring Committee services; consulted for and received honoraria from Bayer; and received research funding from Takeda and Merck. S.S. received research funding from Incyte Corporation, Seattle Genetics, Portola Pharmaceuticals, Pharmacyclics, Acerta Pharma BV, AstraZeneca, Genentech, and Denova Biopharma; received membership on the board of directors or advisory committee for AstraZeneca; consulted for and received research funding from Merck Sharp & Dohme Corp.; and his spouse received researching funding from Ignyta, Bristol-Myers Squibb, and Ayala. S.N. was on the advisory board for Celgene. N.R. consulted for KITE Pharma, Abbvie, and Celgene, received research funding from Genentech; and consulted for and received research funding from BMS. U.F. received honoraria from Celgene and received research funding Publisher Copyright: {\textcopyright} 2021 by The American Society of Hematology.",

year = "2021",

month = jan,

day = "21",

doi = "10.1182/blood.2020006926",

language = "English (US)",

volume = "137",

pages = "374--386",

journal = "Blood",

issn = "0006-4971",

publisher = "American Society of Hematology",

number = "3",

}

TY - JOUR

T1 - Burkitt lymphoma in the modern era

T2 - Real-world outcomes and prognostication across 30 US cancer centers

AU - Evens, Andrew M.

AU - Danilov, Alexey

AU - Jagadeesh, Deepa

AU - Sperling, Amy

AU - Kim, Seo Hyun

AU - Vaca, Ryan

AU - Wei, Catherine

AU - Rector, Daniel

AU - Sundaram, Suchitra

AU - Reddy, Nishitha

AU - Lin, Yong

AU - Farooq, Umar

AU - D'Angelo, Christopher

AU - Bond, David A.

AU - Berg, Stephanie

AU - Churnetski, Michael C.

AU - Godara, Amandeep

AU - Khan, Nadia

AU - Choi, Yun Kyong

AU - Yazdy, Maryam

AU - Rabinovich, Emma

AU - Varma, Gaurav

AU - Karmali, Reem

AU - Mian, Agrima

AU - Savani, Malvi

AU - Burkart, Madelyn

AU - Martin, Peter

AU - Ren, Albert

AU - Chauhan, Ayushi

AU - Diefenbach, Catherine

AU - Straker-Edwards, Allandria

AU - Klein, Andreas K.

AU - Blum, Kristie A.

AU - Boughan, Kirsten Marie

AU - Smith, Scott E.

AU - Haverkos, Brad M.

AU - Orellana-Noia, Victor M.

AU - Kenkre, Vaishalee P.

AU - Zayac, Adam

AU - Ramdial, Jeremy

AU - Maliske, Seth M.

AU - Epperla, Narendranath

AU - Venugopal, Parameswaran

AU - Feldman, Tatyana A.

AU - Smith, Stephen D.

AU - Stadnik, Andrzej

AU - David, Kevin A.

AU - Naik, Seema

AU - Lossos, Izidore S.

AU - Lunning, Matthew A.

AU - Caimi, Paolo

AU - Kamdar, Manali

AU - Palmisiano, Neil

AU - Bachanova, Veronika

AU - Portell, Craig A.

AU - Phillips, Tycel

AU - Olszewski, Adam J.

AU - Alderuccio, Juan Pablo

N1 - Funding Information: from Kite Pharma. N.E. is on the speaker’s bureau for Verastem Oncology and received honoraria from Pharmacyclics. N.K. has membership on an entity’s board of directors or advisory committee for Seattle Genetics and Abbvie; provides educational content/symposium for Janssen; and receives research funds from Bristol Myers. J.A. is an immediate family member who received honoraria from Puma Biotechnology, Agios, Inovio Pharmaceuticals, and Foundation Medicine; receives honoraria from Targeted Oncology; and consults for OncLive. M.Y. receives honoraria from Bayer; receives research funding from Genentech; and consults for Octapharma and Abbvie. C.D. consults for and received research funding from Bristol-Myers Squibb; receives research funding from Denovo; consults for and receives research funding from Gen-entech; receives research funding from Incyte, LAM Therapeutics, MEI, Millenium/Takeda, and Trillium; consults for and receives research funding from Merck; and consults for and receives research funding from Seattle Genetics. R.K. is on the speakers bureau for Astrazeneca; receives institutional research funding from Takeda and BMS; and consults for and is on the speakers bureau for Gilead, Kite, Juno, and Celgene. P.M. consults foe Celgene, Teneobio, Karyopharm, Janssen, Sandoz, and I-MAB. M.K. is on the speakers bureau for Seattle Genetics; consults for Pharmacyclics, AstraZeneca, and Celgene; and is employed by the University of Colorado. C.P. receives research funding from Xencor, Roche/Genentech, Infinity, TG Therapeutics, AbbVie, and Acerta/ AstraZeneca; consults for Pharmacyclics, Janssen, Amgen, and Bayer; and consults for and received research funding from Genentech, Bei-Gene, and Kite. I.L. has membership on an entity’s board of directors or advisory committee for Janssen Scientific and Seattle Genetics and receives research funding from the National Institutes of Health. A.O. receives research funding from Genentech, Adaptive Biotechnologies, TG Therapeutics, and Spectrum Pharmaceuticals. The remaining authors declare no competing financial interests. Funding Information: Conflict-of-interest disclosure: A.E. consulted for and received honoraria from Seattle Genetics; received honoraria from Research to Practice; consulted for and received honoraria from Epizyme; consulted for and received honoraria from Verastem; consulted for and received honoraria from MorphoSys; consulted for and received honoraria from Affimed; received honoraria from Novartis and Pharmacyclics for Data Safety Monitoring Committee services; consulted for and received honoraria from Bayer; and received research funding from Takeda and Merck. S.S. received research funding from Incyte Corporation, Seattle Genetics, Portola Pharmaceuticals, Pharmacyclics, Acerta Pharma BV, AstraZeneca, Genentech, and Denova Biopharma; received membership on the board of directors or advisory committee for AstraZeneca; consulted for and received research funding from Merck Sharp & Dohme Corp.; and his spouse received researching funding from Ignyta, Bristol-Myers Squibb, and Ayala. S.N. was on the advisory board for Celgene. N.R. consulted for KITE Pharma, Abbvie, and Celgene, received research funding from Genentech; and consulted for and received research funding from BMS. U.F. received honoraria from Celgene and received research funding Publisher Copyright: © 2021 by The American Society of Hematology.

PY - 2021/1/21

Y1 - 2021/1/21

N2 - We examined adults with untreated Burkitt lymphoma (BL) from 2009 to 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 the following: median age, 47 years; HIV+, 22%; Eastern Cooperative Oncology Group (ECOG) performance status (PS) 2 to 4, 23%; >1 extranodal site, 43%; advanced stage, 78%; and central nervous system (CNS) involvement, 19%. Treatment-related mortality 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 < .001) and without difference based on setting of administration (ie, inpatient vs outpatient). Outcomes were also improved at an academic vs community cancer center (3-year PFS, 67% vs 46%, P = .006; OS, 72% vs 53%, P = .01). In multivariate models, age ≥ 40 years (PFS, hazard ratio [HR] = 1.70, P = .001; OS, HR = 2.09, P < .001), ECOG PS 2 to 4 (PFS, HR = 1.60, P < .001; OS, HR = 1.74, P = .003), lactate dehydrogenase > 3× normal (PFS, HR = 1.83, P < .001; OS, HR = 1.63, P = .009), and CNS involvement (PFS, HR = 1.52, P = .017; OS, HR = 1.67, P = .014) predicted inferior survival. Furthermore, survival varied based on number of factors present (0, 1, 2 to 4 factors) yielding 3-year PFS rates of 91%, 73%, and 50%, respectively; and 3-year OS rates of 95%, 77%, and 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, clinical prognostic factors at diagnosis identified patients with divergent survival rates.

AB - We examined adults with untreated Burkitt lymphoma (BL) from 2009 to 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 the following: median age, 47 years; HIV+, 22%; Eastern Cooperative Oncology Group (ECOG) performance status (PS) 2 to 4, 23%; >1 extranodal site, 43%; advanced stage, 78%; and central nervous system (CNS) involvement, 19%. Treatment-related mortality 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 < .001) and without difference based on setting of administration (ie, inpatient vs outpatient). Outcomes were also improved at an academic vs community cancer center (3-year PFS, 67% vs 46%, P = .006; OS, 72% vs 53%, P = .01). In multivariate models, age ≥ 40 years (PFS, hazard ratio [HR] = 1.70, P = .001; OS, HR = 2.09, P < .001), ECOG PS 2 to 4 (PFS, HR = 1.60, P < .001; OS, HR = 1.74, P = .003), lactate dehydrogenase > 3× normal (PFS, HR = 1.83, P < .001; OS, HR = 1.63, P = .009), and CNS involvement (PFS, HR = 1.52, P = .017; OS, HR = 1.67, P = .014) predicted inferior survival. Furthermore, survival varied based on number of factors present (0, 1, 2 to 4 factors) yielding 3-year PFS rates of 91%, 73%, and 50%, respectively; and 3-year OS rates of 95%, 77%, and 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, clinical prognostic factors at diagnosis identified patients with divergent survival rates.

UR - http://www.scopus.com/inward/record.url?scp=85095881813&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85095881813&partnerID=8YFLogxK

U2 - 10.1182/blood.2020006926

DO - 10.1182/blood.2020006926

M3 - Article

C2 - 32663292

AN - SCOPUS:85095881813

SN - 0006-4971

VL - 137

SP - 374

EP - 386

JO - Blood

JF - Blood

IS - 3

ER -

Burkitt lymphoma in the modern era: Real-world outcomes and prognostication across 30 US cancer centers

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