Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, FL.
Division of Hematology/Oncology, Brown University, Providence, RI.
Blood Adv. 2021 Jul 27;5(14):2852-2862. doi: 10.1182/bloodadvances.2021004458.
Data addressing prognostication in patients with HIV related Burkitt lymphoma (HIV-BL) currently treated remain scarce. We present an international analysis of 249 (United States: 140; United Kingdom: 109) patients with HIV-BL treated from 2008 to 2019 aiming to identify prognostic factors and outcomes. With a median follow up of 4.5 years, the 3-year progression-free survival (PFS) and overall survival (OS) were 61% (95% confidence interval [CI] 55% to 67%) and 66% (95%CI 59% to 71%), respectively, with similar results in both countries. Patients with baseline central nervous system (CNS) involvement had shorter 3-year PFS (36%) compared to patients without CNS involvement (69%; P < .001) independent of frontline treatment. The incidence of CNS recurrence at 3 years across all treatments was 11% with a higher incidence observed after dose-adjusted infusional etoposide, doxorubicin, vincristine, prednisone, cyclophosphamide (DA-EPOCH) (subdistribution hazard ratio: 2.52; P = .03 vs other regimens) without difference by CD4 count 100/mm3. In multivariate models, factors independently associated with inferior PFS were Eastern Cooperative Oncology Group (ECOG) performance status 2-4 (hazard ratio [HR] 1.87; P = .007), baseline CNS involvement (HR 1.70; P = .023), lactate dehydrogenase >5 upper limit of normal (HR 2.09; P < .001); and >1 extranodal sites (HR 1.58; P = .043). The same variables were significant in multivariate models for OS. Adjusting for these prognostic factors, treatment with cyclophosphamide, vincristine, doxorubicin, and high-dose methotrexate, ifosfamide, etoposide, and high-dose cytarabine (CODOX-M/IVAC) was associated with longer PFS (adjusted HR [aHR] 0.45; P = .005) and OS (aHR 0.44; P = .007). Remarkably, HIV features no longer influence prognosis in contemporaneously treated HIV-BL.
目前，针对接受治疗的 HIV 相关伯基特淋巴瘤（HIV-BL）患者的预后预测数据仍然稀缺。我们对 2008 年至 2019 年间接受治疗的 249 名（美国：140 名；英国：109 名）HIV-BL 患者进行了国际分析，旨在确定预后因素和结果。中位随访 4.5 年后，3 年无进展生存率（PFS）和总生存率（OS）分别为 61%（95%置信区间[CI]55%至 67%）和 66%（95%CI 59%至 71%），两国结果相似。基线时有中枢神经系统（CNS）受累的患者 3 年 PFS 较短（36%），而无 CNS 受累的患者为 69%（P<0.001），且不受一线治疗影响。所有治疗方法中，3 年 CNS 复发的发生率为 11%，在剂量调整的依托泊苷、多柔比星、长春新碱、泼尼松、环磷酰胺（DA-EPOCH）治疗后，复发率更高（亚分布危险比：2.52；P=0.03 与其他方案相比），但与 CD4 计数 100/mm3 无关。多变量模型中，与较差 PFS 独立相关的因素包括东部肿瘤协作组（ECOG）表现状态 2-4（危险比[HR]1.87；P=0.007）、基线时 CNS 受累（HR 1.70；P=0.023）、乳酸脱氢酶>5 正常值上限（HR 2.09；P<0.001）和>1 结外部位（HR 1.58；P=0.043）。这些变量在 OS 的多变量模型中也具有统计学意义。在调整这些预后因素后，接受环磷酰胺、长春新碱、多柔比星和大剂量甲氨蝶呤、异环磷酰胺、依托泊苷和高剂量阿糖胞苷（CODOX-M/IVAC）治疗的患者，PFS 更长（调整后的 HR[aHR]0.45；P=0.005）和 OS（aHR 0.44；P=0.007）。值得注意的是，在同时接受治疗的 HIV-BL 患者中，HIV 特征不再影响预后。
