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; HIV1, 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-monthmedian follow-up, 3-year PFS andOS 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).Outcomeswere 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] 5 1.70, P = .001; OS, HR 5 2.09, P < .001), ECOG PS 2 to 4 (PFS, HR 5 1.60, P < .001; OS, HR 5 1.74, P = .003), lactate dehydrogenase > 33 normal (PFS, HR 5 1.83, P < .001; OS, HR 5 1.63, P = .009), and CNS involvement (PFS, HR5 1.52, P5 .017;OS, HR5 1.67, P5 .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.
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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
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.
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