Efficacy and safety of rituximab-based chemoimmunotherapy in adult patients with Burkitt lymphoma in Korea

TL;DR

This study evaluates rituximab-based treatments for adult Burkitt lymphoma in Korea, finding that while effective, older patients face higher early mortality.

Contribution

The study provides insights into treatment outcomes and prognostic factors for adult Burkitt lymphoma in Korea using rituximab-based regimens.

Findings

R-hyperCVAD/MC showed 5-year overall survival of 69.5% and event-free survival of 65.2%.

Older patients had higher early mortality, with a median survival of 3.9 months.

B-symptoms and age ≥60 years were significant predictors of poor survival.

Abstract

Burkitt lymphoma (BL), a rare, aggressive MYC-driven B-cell non-Hodgkin lymphoma (NHL), has endemic, sporadic, and immunodeficiency-associated variants. In Asia, BL accounts for 1–2% of lymphomas, with limited data available on adult outcomes. Although potentially curable, BL is associated with poor outcomes with low-intensity chemotherapy owing to rapid proliferation and chemoresistance. Therefore, high-intensity regimens including R-hyperCVAD/MC (Course A of rituximab, cyclophosphamide, doxorubicin, vincristine, and dexamethasone; Course B of rituximab, methotrexate, and cytarabine) have been commonly used; however, no optimal strategy has been established.

This retrospective study included 69 adult patients with BL (age >15 years) diagnosed between 2009 and 2023 using the WHO criteria. Most of the patients were administered R-hyperCVAD/MC, while rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) was administered to older patients or those with poor-performance-status to mitigate toxicity.

The median age of the patients was 55 years; 39.1% of the patients had Eastern Cooperative Oncology Group Performance Status (ECOG-PS) of 2–4, 62.3% had >1 extranodal site, 71.0% had stage IV, and 13.0% had central nervous system involvement. Furthermore, 13 (18.8%) patients were reclassified as BL after immunoglobulin heavy‐chain (IGH)/MYC detection. Overall, 52 patients were administered R-hyperCVAD/MC exclusively, 5 switched from R-CHOP, and 4 patients were primarily treated with R-CHOP owing to intolerance. At a median follow-up of 66.9 months, 5-year overall survival (OS) and event-free survival (EFS) were 69.5 and 65.2%, respectively and higher early mortality was observed in older patients (median survival: 3.9 months). Poor OS was associated with B-symptoms (hazard ratio [HR] 3.89, p = 0.003) and age ≥ 60 years (HR 2.54, p = 0.034); while poor EFS was associated with ECOG-PS 2–4 (HR 2.72, p = 0.024).

Our study revealed that R-hyperCVAD/MC was effective but associated with high early mortality in older patients. Risk-adapted regimens and prognostic factors including age, B-symptoms, and ECOG-PS are crucial for optimizing treatment.

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