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Burkitt lymphoma prognostic index may lead to more targeted therapy

Journal of Clinical Oncology
Reuters Health - 08/02/2021 - An international team has developed and validated a prognostic index specific for Burkitt lymphoma to aid in risk stratification, interpretation of clinical trials, and targeted development of novel therapeutic strategies.

Burkitt lymphoma (BL) is a "rare malignancy with a unique biology and clinical course" that has lacked a standardized prognostic model, Dr. Andrew Evens, director of the Lymphoma Program at Rutgers Cancer Institute and Medical Director of the Oncology Service Line at RWJBarnabas Health, in New Brunswick, New Jersey, told Reuters Health by phone.

The Burkitt Lymphoma International Prognostic Index (BL-IPI) is a "simple yet robust" prognostic model that accounts for the unique characteristics of Burkitt lymphoma, added Dr. Evens.

In a paper in the Journal of the Clinical Oncology, he and his colleagues describe how they derived the BL-IPI from a real-world dataset comprising 633 adults with BL treated with immunochemotherapy in the U.S. between 2009 and 2018. They validated the model in an external dataset of 457 patients treated in Europe, Canada and Australia between 2004 and 2019.

In the derivation cohort, the following factors were selected as equally weighted factors with an independent prognostic value: age 40 years or older, performance status greater than or equal to 2, serum lactate dehydrogenase greater than three times the upper limit of normal, and involvement of the central nervous system.

The resulting index identified groups with low risk (no risk factors, 18% of patients), intermediate (one risk factor, 36% of patients) and high risk (two or more risk factors, 46% of patients), with three-year progression-free survival estimates of 92%, 72% and 53%, respectively, and three-year overall survival estimates of 96%, 76% and 59%, respectively.

Results were similar in the validation cohort, with three-year progression-free survival estimates of 96%, 82% and 63% for the low-, intermediate- and high-risk groups.

The BL-IPI discriminated outcomes regardless of HIV status, stage, or first-line chemotherapy regimen.

Of note, said Dr. Evens, is the identification of a group of low-risk patients with "incredible prognosis where the overall survival was greater than 95%. For this group with outstanding prognosis, maybe we can start to de-escalate therapy."

"Conversely," he told Reuters Health, "at the other end of the spectrum prognosis is around 50%. And so whatever we're doing for that group of patients, it's not good enough and we need to design new treatments and new clinical trials for that kind of poor prognosis."

"This novel, validated index can help clinicians more accurately identify a prognosis for their adult Burkitt lymphoma patients, as well as advance targeted clinical research studies," lead author Dr. Adam Olszewski, of the Lifespan Cancer Institute and The Warren Alpert Medical School of Brown University in Providence, Rhode Island, added in a news release.

"It may engender dual goals of de-escalating treatment intensity for patients with low-risk disease and improving survival rates for the high-risk group, the latter which has suboptimal outcomes with standard therapy and should be considered for novel therapeutic strategies," Dr. Olszewski added.

This research was presented in part as an oral presentation at the 62nd American Society of Hematology (ASH) virtual annual meeting, held December 5-8, 2020.

SOURCE: https://bit.ly/3pI32tv Journal of Clinical Oncology, online January 27, 2021.

By Megan Brooks

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