TY - JOUR
T1 - Outcomes of Burkitt lymphoma with central nervous system involvement
T2 - Evidence from a large multicenter cohort study
AU - Zayac, Adam S.
AU - Evens, Andrew M.
AU - Danilov, Alexey
AU - Smith, Stephen D.
AU - Jagadeesh, Deepa
AU - Leslie, Lori A.
AU - Wei, Catherine
AU - Kim, Seo Hyun
AU - Naik, Seema
AU - Sundaram, Suchitra
AU - Reddy, Nishitha
AU - Farooq, Umar
AU - Kenkre, Vaishalee P.
AU - Epperla, Narendranath
AU - Blum, Kristie A.
AU - Khan, Nadia
AU - Singh, Daulath
AU - Alderuccio, Juan P.
AU - Godara, Amandeep
AU - Yazdy, Maryam Sarraf
AU - Diefenbach, Catherine
AU - Rabinovich, Emma
AU - Varma, Gaurav
AU - Karmali, Reem
AU - Shao, Yusra
AU - Trabolsi, Asaad
AU - Burkart, Madelyn
AU - Martin, Peter
AU - Stettner, Sarah
AU - Chauhan, Ayushi
AU - Choi, Yun Kyong
AU - Straker-Edwards, Allandria
AU - Klein, Andreas
AU - Churnetski, Michael C.
AU - Boughan, Kirsten M.
AU - Berg, Stephanie
AU - Haverkos, Bradley M.
AU - Orellana-Noia, Victor M.
AU - D'Angelo, Christopher
AU - Bond, David A.
AU - Maliske, Seth M.
AU - Vaca, Ryan
AU - Magarelli, Gabriella
AU - Sperling, Amy
AU - Gordon, Max J.
AU - David, Kevin A.
AU - Savani, Malvi
AU - Caimi, Paolo
AU - Kamdar, Manali
AU - Lunning, Matthew A.
AU - Palmisiano, Neil
AU - Venugopal, Parameswaran
AU - Portell, Craig A.
AU - Bachanova, Veronika
AU - Phillips, Tycel
AU - Lossos, Izidore S.
AU - Olszewski, Adam J.
N1 - Publisher Copyright:
© 2021 Ferrata Storti Foundation
PY - 2021/7
Y1 - 2021/7
N2 - Central nervous system (CNS) involvement in Burkitt lymphoma poses a major therapeutic challenge, and the relative ability of contemporary regimens to treat CNS involvement remains uncertain. We describe the prognostic significance of CNS involvement and the incidence of CNS recurrence/progression after contemporary immunochemotherapy using real-world clinicopathological data from adults with Burkitt lymphoma diagnosed between 2009 and 2018 in 30 institutions in the USA. We examined associations between baseline CNS involvement, patients' characteristics, complete response rates, and survival. We also examined risk factors for CNS recurrence. Of 641 patients (aged 18 to 88 years), 120 (19%) had CNS involvement. CNS involvement was independently associated with human immunodeficiency virus infection, poor performance status, involvement of ≥2 extranodal sites, and bone marrow involvement. Selection of the first-line treatment regimen was unaffected by CNS involvement (P=0.93). Patients with CNS disease had significantly lower rates of complete response (59% vs. 77% for patients with and without CNS involvement, respectively; P<0.001), worse 3-year progression-free survival (adjusted hazard ratio [aHR]=1.53, 95% confidence interval [95% CI]: 1.14-2.06; P=0.004) and overall survival (aHR=1.62, 95% CI: 1.18-2.22; P=0.003). The 3-year cumulative incidence of CNS recurrence was 6% (95% CI: 4-8%) and was significantly lower among patients receiving other regimens (CODOX-M/IVAC, 4%, or hyperCVAD/MA, 3%) compared with DA-EPOCH-R (13%; adjusted sub-distribution HR=4.38, 95% CI:, 2.16-8.87; P<0.001). Baseline CNS involvement in Burkitt lymphoma is relatively common and portends inferior prognosis independently of the first-line treatment regimen selected. In real-world practice, regimens including intravenous systemic agents with pronounced CNS penetrance were associated with a lower risk of CNS recurrence. This finding may be influenced by observed suboptimal adherence to the strict CNS staging and intrathecal therapy procedures incorporated in the DA-EPOCH-R regimen.
AB - Central nervous system (CNS) involvement in Burkitt lymphoma poses a major therapeutic challenge, and the relative ability of contemporary regimens to treat CNS involvement remains uncertain. We describe the prognostic significance of CNS involvement and the incidence of CNS recurrence/progression after contemporary immunochemotherapy using real-world clinicopathological data from adults with Burkitt lymphoma diagnosed between 2009 and 2018 in 30 institutions in the USA. We examined associations between baseline CNS involvement, patients' characteristics, complete response rates, and survival. We also examined risk factors for CNS recurrence. Of 641 patients (aged 18 to 88 years), 120 (19%) had CNS involvement. CNS involvement was independently associated with human immunodeficiency virus infection, poor performance status, involvement of ≥2 extranodal sites, and bone marrow involvement. Selection of the first-line treatment regimen was unaffected by CNS involvement (P=0.93). Patients with CNS disease had significantly lower rates of complete response (59% vs. 77% for patients with and without CNS involvement, respectively; P<0.001), worse 3-year progression-free survival (adjusted hazard ratio [aHR]=1.53, 95% confidence interval [95% CI]: 1.14-2.06; P=0.004) and overall survival (aHR=1.62, 95% CI: 1.18-2.22; P=0.003). The 3-year cumulative incidence of CNS recurrence was 6% (95% CI: 4-8%) and was significantly lower among patients receiving other regimens (CODOX-M/IVAC, 4%, or hyperCVAD/MA, 3%) compared with DA-EPOCH-R (13%; adjusted sub-distribution HR=4.38, 95% CI:, 2.16-8.87; P<0.001). Baseline CNS involvement in Burkitt lymphoma is relatively common and portends inferior prognosis independently of the first-line treatment regimen selected. In real-world practice, regimens including intravenous systemic agents with pronounced CNS penetrance were associated with a lower risk of CNS recurrence. This finding may be influenced by observed suboptimal adherence to the strict CNS staging and intrathecal therapy procedures incorporated in the DA-EPOCH-R regimen.
UR - http://www.scopus.com/inward/record.url?scp=85111174760&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85111174760&partnerID=8YFLogxK
U2 - 10.3324/haematol.2020.270876
DO - 10.3324/haematol.2020.270876
M3 - Article
C2 - 33538152
AN - SCOPUS:85111174760
SN - 0390-6078
VL - 106
SP - 1932
EP - 1942
JO - Haematologica
JF - Haematologica
IS - 7
ER -
