Page 165 - 2021_07-Haematologica-web

Real-world CNS outcomes in Burkitt lymphoma
nine, seven, and four patients, respectively.
The patients’ characteristics associated with baseline
CNS involvement in univariate analysis included HIV infec- tion, B symptoms, PS 2-4, low hemoglobin or albumin, high LDH, ≥2 non-CNS extranodal sites of involvement, and invasion of the bone marrow, liver, kidneys, or adrenal glands (Online Supplementary Table S1). Conversely, patients with extranodal involvement of the intestine were less like- ly to present with CNS disease. In a multivariate model, HIV infection (aOR: 1.84 [1.12-3.03], P=0.017), poor PS (aOR=2.13 [1.27-3.57], P=0.004), ≥2 extranodal sites (aOR=2.94 [1.75-4.94], P<0.001), and bone marrow involvement (aOR=2.80 [1.59-4.94], P<0.001) retained sta- tistical significance, whereas intestinal involvement was consistently associated with a lower risk (aOR=0.34 [0.16- 0.72], P=0.005).
The use of first-line regimens did not differ significantly according to baseline CNS involvement (P=0.93) (Figure 1B). Furthermore, we observed no significant difference in receipt of any intrathecal chemotherapy (89% vs. 84%, respectively; P=0.16) or systemic HDMTX (67% vs. 61%, respectively; P=0.22). Radiation therapy was used some- what more frequently in patients with CNS disease (11%
vs. 6%, P=0.05), but data on the specific radiation target were not available. Among 20 patients with parenchymal CNS involvement, four (20%) received DA-EPOCH-R, seven (35%) received CODOX-M/IVAC, eight (40%) received hyperCVAD/M, and one received a low-intensity regimen.
Among 35 BL patients given DA-EPOCH-R who had CNS invasion, 29 (83%) had only leptomeningeal disease, four (11%) had parenchymal disease, and two (6%) had unspecified involvement. Thirty-four of these 35 patients received care in academic centers. Details of intrathecal administrations were available for 21 patients (60%). Although all 21 received intrathecal chemotherapy, only 45% followed the strict schedule from the original protocol (first twice-weekly, then weekly, and then monthly admin- istration). The median number of intrathecal methotrexate administrations was eight (IQR, 5-12). Clearance of CSF disease was recorded in 89% of patients.
Outcomes of patients with baseline central nervous system involvement
Patients with baseline CNS involvement had a signifi- cantly lower probability of attaining a complete response:
AB
CD
Figure 1. Baseline central nervous system involvement in Burkitt lymphoma. (A) Proportions of patients with leptomeningeal, parenchymal, or unspecified central nervous system (CNS) involvement; 11 patients with concurrent leptomeningeal and parenchymal disease are included in the last group. (B) Use of first-line chemotherapy regimens stratified by the presence of baseline CNS involvement. (C) Progression-free survival stratified by the presence of CNS involvement. (D) Overall survival stratified by the presence of CNS involvement. Shaded areas indicate 95% confidence interval bands; 3-year survival estimates and P-values from log-rank test are listed. NR: not reached.
haematologica | 2021; 106(7)
1935