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Hess BT, Giri A, Park Y, Patel KK, Link BK, Nowakowski GS, Maliske SM, Fortin S, Chavez JC, Saeed H, Hill BT, Mejia Garcia AV, Maddocks KJ, Hanel W, Wagner‐Johnston ND, Messmer MR, Kahl BS, Watkins M, Alderuccio JP, Lossos IS, Nathan S, Orellana‐Noia VM, Portell CA, Landsburg DJ, Ayers EC, Castillo JJ. Outcomes of patients with limited-stage plasmablastic lymphoma: A multi-institutional retrospective study. Am J Hematol 2023; 98:300-308. [PMID: 36588409 PMCID: PMC10107934 DOI: 10.1002/ajh.26784] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 11/11/2022] [Accepted: 11/14/2022] [Indexed: 01/03/2023]
Abstract
Plasmablastic lymphoma (PBL) is a rare entity, commonly associated with immunosuppressed states such as human immunodeficiency virus (HIV) infection or solid organ transplant. The clinical course is characterized by high relapse rates and a poor prognosis, leading some clinicians to recommend aggressive frontline therapy. However, a specific review of limited stage (LS) PBL patients is not available to evaluate outcomes and justify treatment recommendations. We performed a retrospective review of LS PBL cases to provide insight into this rare disease. Our cohort consisted of 80 stage I or II PBL patients from 13 US academic centers. With a median follow up of 34 months (1-196), the 3-year progression-free survival (PFS) and overall survival (OS) of the entire cohort were 72% (95% CI 62, 83) and 79% (95% CI 70, 89), respectively. The 3-year PFS and OS of patients treated with frontline chemotherapy alone was 65% (95% CI 50, 84) and 71% (95% CI 56, 89), respectively, compared to 85% (95% CI 72, 100) and 96% (95% CI 89, 100), respectively, in patients treated with combined frontline chemotherapy with radiation consolidation. Our data demonstrate favorable outcomes in LS PBL with no improvements in outcome from aggressive frontline treatment including Hyper-CVAD or auto-SCT consolidation. Multivariate regression analysis (MRA) demonstrated improved PFS for patients receiving EPOCH based frontline therapy versus CHOP (HR: 0.23; p = 0.029). Frontline chemotherapy followed by radiation consolidation versus chemotherapy alone appeared to be associated with improved relapse and survival outcomes but did not show statistical significance in MRA.
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Affiliation(s)
- Brian T. Hess
- Hollings Cancer CenterMedical University of South CarolinaCharlestonSouth CarolinaUSA
| | - Anshu Giri
- Fox Chase Cancer CenterPhiladelphiaPennsylvaniaUSA
| | - Yeonhee Park
- Hollings Cancer CenterMedical University of South CarolinaCharlestonSouth CarolinaUSA
| | - Krina K. Patel
- Department of Lymphoma/MyelomaThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Brian K. Link
- Division of Hematology, Oncology, and Blood & Marrow TransplantationUniversity of IowaIowa CityIowaUSA
| | | | - Seth M. Maliske
- Roger Maris Cancer Center Sanford HealthFargoNorth DakotaUSA
| | | | - Julio C. Chavez
- Department of Malignant HematologyMoffitt Cancer CenterTampaFloridaUSA
| | - Hayder Saeed
- Department of Malignant HematologyMoffitt Cancer CenterTampaFloridaUSA
| | - Brian T. Hill
- Taussig Cancer Institute, Department of Hematology and Medical OncologyCleveland Clinic FoundationClevelandOhioUSA
| | - Alex V. Mejia Garcia
- Taussig Cancer Institute, Department of Hematology and Medical OncologyCleveland Clinic FoundationClevelandOhioUSA
| | | | - Walter Hanel
- Division of HematologyThe Ohio State UniversityColumbusOhioUSA
| | | | | | - Brad S. Kahl
- Siteman Cancer CenterWashington University School of MedicineSt. LouisMissouriUSA
| | - Marcus Watkins
- Siteman Cancer CenterWashington University School of MedicineSt. LouisMissouriUSA
| | - Juan Pablo Alderuccio
- Sylvester Comprehensive Cancer CenterUniversity of Miami School of MedicineMiamiFloridaUSA
| | - Izidore S. Lossos
- Sylvester Comprehensive Cancer CenterUniversity of Miami School of MedicineMiamiFloridaUSA
| | | | | | - Craig A. Portell
- Division of Hematology/OncologyUniversity of VirginiaCharlottesvilleVirginiaUSA
| | | | - Emily C. Ayers
- Division of Hematology/OncologyUniversity of VirginiaCharlottesvilleVirginiaUSA
| | - Jorge J. Castillo
- Department of Medical OncologyDana‐Farber Cancer Institute, Harvard Medical SchoolBostonMassachusettsUSA
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Zayac AS, Evens AM, Danilov A, Smith SD, Jagadeesh D, Leslie LA, Wei C, Kim SH, Naik S, Sundaram S, Reddy N, Farooq U, Kenkre VP, Epperla N, Blum KA, Khan N, Singh D, Alderuccio JP, Godara A, Yazdy MS, Diefenbach C, Rabinovich E, Varma G, Karmali R, Shao Y, Trabolsi A, Burkart M, Martin P, Stettner S, Chauhan A, Choi YK, Straker-Edwards A, Klein A, Churnetski MC, Boughan KM, Berg S, Haverkos BM, Orellana-Noia VM, D'Angelo C, Bond DA, Maliske SM, Vaca R, Magarelli G, Sperling A, Gordon MJ, David KA, Savani M, Caimi P, Kamdar M, Lunning MA, Palmisiano N, Venugopal P, Portell CA, Bachanova V, Phillips T, Lossos IS, Olszewski AJ. Outcomes of Burkitt lymphoma with central nervous system involvement: evidence from a large multicenter cohort study. Haematologica 2021; 106:1932-1942. [PMID: 33538152 PMCID: PMC8252937 DOI: 10.3324/haematol.2020.270876] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Indexed: 11/09/2022] Open
Abstract
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.
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Affiliation(s)
- Adam S Zayac
- Lifespan Cancer Institute, Alpert Medical School of Brown University, Providence, RI
| | - Andrew M Evens
- Rutgers Cancer Institute of New Jersey, Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Alexey Danilov
- Knight Cancer Institute, Oregon Health and Science University, Portland, OR
| | - Stephen D Smith
- University of Washington/Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - Lori A Leslie
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ
| | - Catherine Wei
- Rutgers Cancer Institute of New Jersey, Robert Wood Johnson University Hospital, New Brunswick, NJ
| | | | - Seema Naik
- Penn State Cancer Institute, Penn State University College of Medicine, Hershey, PA
| | | | | | - Umar Farooq
- University of Iowa Carver College of Medicine, Iowa City, IA
| | | | | | | | - Nadia Khan
- Fox Chase Cancer Center, Philadelphia, PA
| | - Daulath Singh
- Loyola University Medical Center, Loyola University Chicago, Maywood, IL
| | - Juan P Alderuccio
- Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, FL
| | | | - Maryam Sarraf Yazdy
- Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC
| | | | | | | | | | - Yusra Shao
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Asaad Trabolsi
- Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, FL
| | | | | | | | - Ayushi Chauhan
- Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC
| | - Yun Kyong Choi
- New York University School of Medicine, Perlmutter Cancer Center, New York, NY
| | | | | | | | | | - Stephanie Berg
- Loyola University Medical Center, Loyola University Chicago, Maywood, IL
| | | | | | | | - David A Bond
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Seth M Maliske
- University of Iowa Carver College of Medicine, Iowa City, IA
| | - Ryan Vaca
- Penn State Cancer Institute, Penn State University College of Medicine, Hershey, PA
| | - Gabriella Magarelli
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ
| | - Amy Sperling
- University of Washington/Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Max J Gordon
- Knight Cancer Institute, Oregon Health and Science University, Portland, OR
| | - Kevin A David
- Rutgers Cancer Institute of New Jersey, Robert Wood Johnson University Hospital, New Brunswick, NJ
| | | | - Paolo Caimi
- University Hospitals Seidman Cancer Center, Cleveland, OH
| | | | | | - Neil Palmisiano
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | | | - Craig A Portell
- University of Virginia School of Medicine, Charlottesville, VA
| | | | | | - Izidore S Lossos
- Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, FL
| | - Adam J Olszewski
- Lifespan Cancer Institute, Alpert Medical School of Brown University, Providence, RI.
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3
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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. Burkitt lymphoma in the modern era: real-world outcomes and prognostication across 30 US cancer centers. Blood 2021; 137:374-386. [PMID: 32663292 PMCID: PMC8765121 DOI: 10.1182/blood.2020006926] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/01/2020] [Indexed: 11/20/2022] Open
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.
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Affiliation(s)
- Andrew M Evens
- Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Alexey Danilov
- Division of Hematology & Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR
| | - Deepa Jagadeesh
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Amy Sperling
- Division of Medical Oncology, University of Washington/Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Seo-Hyun Kim
- Division of Hematology/Oncology, Rush University Medical Center, Chicago, IL
| | - Ryan Vaca
- Division of Hematology/Oncology, Penn State Cancer Institute, Penn State University College of Medicine, Hershey, PA
| | - Catherine Wei
- Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Daniel Rector
- Division of Hematology/Oncology, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ
| | - Suchitra Sundaram
- Division of Hematology/Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Nishitha Reddy
- Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, TN
| | - Yong Lin
- Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Umar Farooq
- Division of Hematology, Oncology, and Blood & Marrow Transplantation, University of Iowa, Iowa City, IA
| | - Christopher D'Angelo
- Division of Hematology/Oncology, Carbone Cancer Center, University of Wisconsin, Madison, WI
| | - David A Bond
- Division of Hematology, James Cancer Center, The Ohio State University Hospital, Columbus, OH
| | - Stephanie Berg
- Division of Hematology/Oncology, Loyola University Medical Center, Maywood, IL
| | - Michael C Churnetski
- Division of Hematology/Oncology, Winship Cancer Institute, Emory University Medical Center, Atlanta, GA
| | - Amandeep Godara
- Division of Hematology/Oncology, Tufts Medical Center, Boston, MA
| | - Nadia Khan
- Division of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - Yun Kyong Choi
- Division of Hematology/Oncology, NYU Cancer Institute, New York University School of Medicine, New York, NY
| | - Maryam Yazdy
- Division of Hematology/Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC
| | - Emma Rabinovich
- Division of Hematology/Oncology, University of Illinois at Chicago, Chicago, IL
| | - Gaurav Varma
- Division of Hematology/Oncology, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY
| | - Reem Karmali
- Division of Hematology/Oncology, Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Agrima Mian
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Malvi Savani
- Division of Hematology/Oncology, University of Minnesota, Minneapolis, MN
| | - Madelyn Burkart
- Division of Hematology/Oncology, Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Peter Martin
- Division of Hematology/Oncology, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY
| | - Albert Ren
- Division of Hematology/Oncology, University of Illinois at Chicago, Chicago, IL
| | - Ayushi Chauhan
- Division of Hematology/Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC
| | - Catherine Diefenbach
- Division of Hematology/Oncology, NYU Cancer Institute, New York University School of Medicine, New York, NY
| | | | - Andreas K Klein
- Division of Hematology/Oncology, Tufts Medical Center, Boston, MA
| | - Kristie A Blum
- Division of Hematology/Oncology, Winship Cancer Institute, Emory University Medical Center, Atlanta, GA
| | - Kirsten Marie Boughan
- Division of Hematology/Oncology, University Hospitals Seidman Cancer Center, Cleveland, OH
| | - Scott E Smith
- Division of Hematology/Oncology, Loyola University Medical Center, Maywood, IL
| | | | | | - Vaishalee P Kenkre
- Division of Hematology/Oncology, Carbone Cancer Center, University of Wisconsin, Madison, WI
| | - Adam Zayac
- Division of Hematology/Oncology, Brown University, Providence, RI
| | - Jeremy Ramdial
- Division of Hematology, Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, FL
| | - Seth M Maliske
- Division of Hematology, Oncology, and Blood & Marrow Transplantation, University of Iowa, Iowa City, IA
| | - Narendranath Epperla
- Division of Hematology, James Cancer Center, The Ohio State University Hospital, Columbus, OH
| | | | - Tatyana A Feldman
- Division of Hematology/Oncology, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ
| | - Stephen D Smith
- Division of Medical Oncology, University of Washington/Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Andrzej Stadnik
- Division of Hematology & Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR
| | - Kevin A David
- Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Seema Naik
- Division of Hematology/Oncology, Penn State Cancer Institute, Penn State University College of Medicine, Hershey, PA
| | - Izidore S Lossos
- Division of Hematology, Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, FL
| | - Matthew A Lunning
- Division of Hematology/Oncology, University of Nebraska, Omaha, Nebraska
| | - Paolo Caimi
- Division of Hematology/Oncology, University Hospitals Seidman Cancer Center, Cleveland, OH
| | - Manali Kamdar
- Division of Hematology, University of Colorado, Denver, CO
| | - Neil Palmisiano
- Division of Hematology/Oncology, Thomas Jefferson University Hospital, Philadelphia, PA; and
| | - Veronika Bachanova
- Division of Hematology/Oncology, University of Minnesota, Minneapolis, MN
| | - Craig A Portell
- Division of Hematology/Oncology, University of Virginia, Charlottesville, VA
| | - Tycel Phillips
- Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI
| | - Adam J Olszewski
- Division of Hematology/Oncology, Brown University, Providence, RI
| | - Juan Pablo Alderuccio
- Division of Hematology, Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, FL
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