Patients with nonendemic Burkitt lymphoma (BL) who reach 12 months of postremission event-free survival (EFS) after intensive immunochemotherapy may have life expectancies similar to that of the general population, according to a paper published in the British Journal of Haematology.

Given that intensive chemotherapeutic regimens for nonendemic BL are linked to life-threatening adverse events­, it is unclear whether findings from clinical trials indicating the superiority of these regimens will translate to real-world settings. For this study, researchers analyzed data from population-based lymphoma registries in Australia to determine whether intensive immunochemotherapy yields favorable outcomes among patients with BL.

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A total of 264 patients were included in the study. The median age was 47 years (range, 18-81), 200 patients (76%) were male, 91 (34%) had an Eastern Cooperative Oncology Group (ECOG) status greater than 1, 190 (73%) had elevated lactate dehydrogenase (LDH), and 226 (86%) had extranodal disease.

The treatment breakdowns were as follows: 47% of patients received cyclophosphamide, vincristine, doxorubicin, intrathecal cytarabine, high-dose methotrexate, intrathecal methotrexate/etoposide, ifosfamide, cytarabine, and intrathecal methotrexate plus rituximab (R-CODOX-M/IVAC); 16% of patients received hyperfractionated cyclophosphamide, vincristine, doxorubicin, dexamethasone, intrathecal methotrexate, and cytarabine alternated with high-dose methotrexate and cytarabine plus rituximab (R-hyper-CVAD); 11% of patients received dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin plus rituximab (DA-EPOCH-R); 35% of patients received prednisone, cyclophosphamide, high-dose methotrexate, dexamethasone, ifosfamide, etoposide, plus or minus teniposide, doxorubicin, vincristine, cytarabine, plus or minus vindesine, intrathecal methotrexate, intrathecal cytarabine, and intrathecal dexamethasone plus rituximab (R-BFM/GMALL); and 2% of patients received other treatment regimens.

In the overall cohort, the 2-year overall survival and EFS rates were 84% and 80%, respectively. Among patients who reached complete remission or for whom complete remission was unconfirmed, the 2-year relapse risk was 6%.

Among patients who reached 12 months of postremission EFS, 2-year relapse risk was 0.6%. No cases of mortality were noted among women or patients between 40 and 59 years of age who reached 12 months of postremission EFS. Patients who reached 12 months of postremission EFS had a life expectancy similar to that of the general population.

“Future research efforts should focus on inclusion of novel agents and/or further refined dynamic risk-adapted treatment strategies based on early therapy response to reduce treatment toxicity without compromising efficacy,” the researchers wrote.

Reference

1.     Jakobsen LH, Ellin F, Smeland KB, et al. Minimal relapse risk and early normalization of survival for patients with Burkitt lymphoma treated with intensive immunochemotherapy: an international study of 264 real-world patients [published online February 4, 2020]. Br J Haematol. doi:10.1111/bjh.16425