Burkitt Lymphoma: Advanced Stage Strongly Matters

Abstract

An ideal prognostic index in Burkitt lymphoma is lacking. Although recently developed Burkitt Lymphoma International Prognostic Index (BL-IPI) shows promise, the fact it doesn't include advanced stage is a matter of concern. We aimed to investigate advanced stage as a risk factor and propose a new prognostic score accordingly. This multicenter retrospective cohort study includes data of 101 adults. Advanced stage demonstrated poor prognosis along with age, lactate dehydrogenase (LDH), uric acid, and Eastern Cooperative Oncology Group Performance Score (ECOG PS). Even though BL- IPI performed well in the whole cohort, it wasn't efficient enough in the advanced stage subset. The alternative score consisted of age >= 55 years (1 point), LDH > 10 x ULN (1 point), hyperuricemia (1 point), ECOG PS >= 2 (2 points), and advanced stage (2 points). Low (<= 1 point), intermediate (2-4 points), and highrisk (>= 5 points) groups consisted of 18%, 59%, and 23% of the patients respectively. 3-year overall survival (OS) rates were 87.1%, 59.5%, and 0% (p< 0.001) whereas 3-year disease-free survival (DFS) rates were 83.3%, 53.5%, and 0% (p= 0.002). Advanced stage indicates poor prognosis independently. An ideal prognostic system should include it as a risk factor. Our risk score carves a path to the ideal risk score, however more studies with higher number of patients are needed to validate it.