# Long-Term Survival Rates and Treatment Trends of Burkitt Lymphoma in Patients with HIV—A National Cancer Database (NCDB) Study

## TL;DR

This study finds that people with HIV and Burkitt lymphoma have higher mortality rates after the first three months compared to those without HIV.

## Contribution

The study reveals a 55% increased risk of death for HIV-associated Burkitt lymphoma patients from months 3 to 60 post-diagnosis.

## Key findings

- HIV-positive Burkitt lymphoma patients had a 55% higher risk of death from months 3 to 60 compared to non-HIV patients.
- Combination chemotherapy and immunotherapy reduced death risk by 45% in the first 3 months for HIV-positive patients.
- The mortality difference between HIV and non-HIV patients was statistically significant from month 3 to 60.

## Abstract

AIDS remains a worldwide epidemic, and approximately 1.2 million people are living with HIV in the United States. Burkitt lymphoma accounts for 10–35% of AIDS-defining lymphoma in people with HIV. The aim of our retrospective database study was to assess the long-term survival rates of HIV-associated Burkitt lymphoma on a national level. We found that there was an increased mortality rate of HIV-associated Burkitt lymphoma, and there was a 55% increased risk of death from months 3 to 60 from the time of diagnosis for HIV-associated Burkitt lymphoma compared to patients with Burkitt lymphoma without HIV. Additionally, risk of death was significantly decreased in patients with HIV treated with combination chemotherapy and immunotherapy compared to patients without HIV treated with combination chemotherapy and immunotherapy in the first 3 months following BL diagnosis.

Background: Burkitt lymphoma (BL) accounts for 10–35% of AIDS-defining lymphoma in people with HIV (PWH). Previous research consisting of smaller cohorts has shown decreased survival for HIV-associated BL. This study aims to compare overall mortality in BL patients with and without HIV, while investigating impact of treatment modalities in HIV-associated BL. Methods: Using the 2004–2019 NCDB, we identified 4312 patients with stage 3 or 4 BL who had a known HIV status and received either chemotherapy alone or chemotherapy and immunotherapy. Time to death was evaluated using Kaplan–Meier survival estimates. Risk of death was evaluated using an extended multivariable Cox model adjusted for multiple factors and with a Heaviside function for HIV status by time period (0–3 month vs. 3–60 month). Results: Of the 4312 patients included, 1514 (35%) had HIV. For months 0–3 from time of diagnosis, HIV status was not associated with a statistically significant increase in risk of death (HR = 1.04, 95% CI: 0.86, 1.26, p = 0.6648). From month 3to 60, positive HIV status was associated with a 55% increase in risk of death compared to those without HIV (95% CI: 1.38, 1.75, p < 0.0001). Further, this difference in hazard rates (0–3 vs. 3–60) was statistically significant (HR = 1.49, 95% CI: 1.22–1.82, p < 0.001). Conclusions: There is an increased mortality rate from months 3 to 60 in BL patients with HIV compared to patients without HIV. Additionally, risk of death in the first 3 months is significantly decreased by 45% in patients with HIV treated with combination chemotherapy and immunotherapy compared to patients without HIV receiving combination chemotherapy and immunotherapy, providing valuable clinical insight into treatment decision making in the care of HIV-associated BL.