Outcomes of HIV-associated Burkitt Lymphoma in Brazil: High treatment toxicity and refractoriness rates - A multicenter cohort study.

Autor: Silva WFD; Instituto do Cancer de Sao Paulo (ICESP), Universidade de São Paulo, Av. Dr. Arnaldo, 251 - Cerqueira César, São Paulo, SP, 01246-000, Brazil. Electronic address: wellington.fernandes@hc.fm.usp.br., Garibaldi PMM; Hospital das Clínicas da Faculdade de Medicina de Ribeirao Preto (HCRP), Av. Bandeirantes, 3900 - Vila Monte Alegre, Ribeirão Preto, SP, 14049-900, Brazil., Rosa LID; Instituto do Cancer de Sao Paulo (ICESP), Universidade de São Paulo, Av. Dr. Arnaldo, 251 - Cerqueira César, São Paulo, SP, 01246-000, Brazil; HEMOMED - Instituto de Oncologia e Hematologia, Av. Arnolfo Azevedo, 121 - Pacaembu, São Paulo, SP, 01236-030, Brazil., Bellesso M; Instituto do Cancer de Sao Paulo (ICESP), Universidade de São Paulo, Av. Dr. Arnaldo, 251 - Cerqueira César, São Paulo, SP, 01246-000, Brazil; HEMOMED - Instituto de Oncologia e Hematologia, Av. Arnolfo Azevedo, 121 - Pacaembu, São Paulo, SP, 01236-030, Brazil., Clé DV; Hospital das Clínicas da Faculdade de Medicina de Ribeirao Preto (HCRP), Av. Bandeirantes, 3900 - Vila Monte Alegre, Ribeirão Preto, SP, 14049-900, Brazil., Delamain MT; Hospital de Clínicas da Universidade Estadual de Campinas (Unicamp), R. Vital Brasil, 251 - Cidade Universitária, Campinas, SP, 13083-888, Campinas, Brazil., Rego EM; Instituto do Cancer de Sao Paulo (ICESP), Universidade de São Paulo, Av. Dr. Arnaldo, 251 - Cerqueira César, São Paulo, SP, 01246-000, Brazil; Laboratory of Medical Investigation on Pathogenesis and Targeted Therapy in Onco-immuno-hematology (LIM-31), Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, 155 - Cerqueira César, São Paulo, SP, 05403-000, Brazil., Pereira J; Instituto do Cancer de Sao Paulo (ICESP), Universidade de São Paulo, Av. Dr. Arnaldo, 251 - Cerqueira César, São Paulo, SP, 01246-000, Brazil; Laboratory of Medical Investigation on Pathogenesis and Targeted Therapy in Onco-immuno-hematology (LIM-31), Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, 155 - Cerqueira César, São Paulo, SP, 05403-000, Brazil., Rocha V; Instituto do Cancer de Sao Paulo (ICESP), Universidade de São Paulo, Av. Dr. Arnaldo, 251 - Cerqueira César, São Paulo, SP, 01246-000, Brazil; Laboratory of Medical Investigation on Pathogenesis and Targeted Therapy in Onco-immuno-hematology (LIM-31), Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, 155 - Cerqueira César, São Paulo, SP, 05403-000, Brazil.
Jazyk: angličtina
Zdroj: Leukemia research [Leuk Res] 2020 Feb; Vol. 89, pp. 106287. Date of Electronic Publication: 2019 Dec 10.
DOI: 10.1016/j.leukres.2019.106287
Abstrakt: Background: Although the increased use of combined antiretroviral therapy (cART) has decreased the incidence of lymphomas HIV-associated, Burkitt lymphoma (BL) incidence remains stable. Reported outcomes on HIV-associated BL from developed countries seem to corroborate that the regimens do not need to be tailored to the HIV-positive population.
Materials and Methods: This is a retrospective multicenter cohort study from Brazil, including HIV-positive patients aged 15 years and above diagnosed with BL.
Results: A total of 54 patients were included. Median age was 39 years (range, 15-64). At diagnosis, advanced disease was found in 86% and 52% had a CD4+ count lower than 200 cells/mm 3 . Five patients died before starting any regimen. Among the remaining 49 patients, most were treated with Hyper-CVAD (53%) and CODOX-M IVAC (18%). Rituximab was used in frontline in only 16% of the patients. Primary refractory disease was found in 14%. A treatment-related mortality of 38.7% and a complete response rate of 44.9% were found. At 4 years, estimated overall survival (OS) was 39.8%. All relapsed and primary refractory patients eventually died. Remaining patients died from infections (24/34), despite antimicrobial prophylaxis and associated cART.
Conclusion: Early mortality and toxicity were higher in our cohort than in developed countries. A faster diagnosis, better understanding of the biology of the disease, establishment of low toxicity regimens, inclusion of rituximab and improvement of supportive care may decrease the mortality of HIV-associated BL in developing countries.
Competing Interests: Declarations of Competing Interest None.
(Copyright © 2019 Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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