Adult patients with advanced Burkitt lymphoma have excellent outcomes with intensive immunochemotherapy protocols, according to findings from a large real-word observational study.
Data for 264 adults derived from lymphoma registries in six countries showed that most had early normalisation of survival and minimal risk of relapse when treated with rituximab containing dose-intense chemotherapy protocols.
The most frequently used intensive chemotherapy protocol was R-CODOX-M/IVAC (47% of the patients), while R-BFM/GMALL and R-hyper-CVAD were used in 66 (25%) and 41 (16%) patients respectively, and 28 (11%) received DA-EPOCH-R.
There was an overall response rate of 89%, with a two-year overall survival and event-free survival of 84% and 80% respectively, according to the study published in the British Journal of Haematology.
For patients in complete remission/unconfirmed, the two-year relapse risk was 6% but relapse risk diminished to 0.6% for patients reaching 12 months of post-remission event-free survival. For these patients the average loss of lifetime was 0.4 months, even for patients with CNS involvement at diagnosis.
A better overall survival rate was seen among patients treated with R-CODOX-M/IVAC compared to R-hyper-CVAD, but this was not significant after adjusting for age, gender and stage.
The study investigators said the low relapse risk after 12 months in remission, was an important finding for developing meaningful follow-up strategies with increased focus on survivorship and less focus on routine disease surveillance.
“[This] can reassure BL patients and their families as well as guide appropriate use of limited health care resources,” they wrote.
“However, the dismal outcomes among patients who are refractory or relapse highlight an unmet medical need in this subgroup.
They said future research efforts in BL should focus on inclusion of novel agents and further refined dynamic risk-adapted treatment strategies based on early therapy response to reduce treatment toxicity without compromising efficacy.