Researchers have created a prognostic index specific to Burkitt lymphoma (BL) that will allow for simplified stratification and comparison of risk distribution in geographically diverse cohorts. Adam J. Olszewski, MD, of Lifespan Cancer Institute at Rhode Island Hospital and the Warren Alpert Medical School of Brown University, presented information on the new prognostic index (BL-IPI) at the 2020 ASH Annual Meeting. “Unfortunately, the traditional International Prognostic Index [IPI] is not very useful in this disease primarily because BL is quite different from diffuse large B-cell lymphoma,” Dr. Olszewski said. “It presents at a younger age, the vast majority of patients present with advanced disease and abnormal lactate dehydrogenase [LDH] levels, which means these factors are not useful in identifying patients that are truly high risk.” The prognostic index was derived using a large real-world evidence cohort of 633 U.S. adults treated for BL from 2009 to 2018. The primary outcome was progression-free survival (PFS), defined as the time from diagnosis until recurrence, progression, death, or censoring. The researchers identified optimal prognostic cutoffs of age 40 or older, LDH >3 times the upper limit of normal (ULN), hemoglobin <11.5 g/dL, and albumin <3.5 g/dL. The multivariable model established four independent factors prognostic of disease severity: age 40 and older, LDH >3 times ULN, ECOG performance status of 2 or more, and central nervous system (CNS) involvement. Of note, adding stage did not enhance the model. The model categorized the 633 patients in the derivation cohort as:
- low-risk (0 factors; 18%)
- intermediate-risk (1 factor; 36%)
- high-risk (2-4 factors; 46%)
Reference Olszewski AJ, Jakobsen LH, Collins GP, et al. The Burkitt Lymphoma International Prognostic Index (BL-IPI). Abstract #705. Presented at the 2020 American Society of Hematology Annual Meeting, December 7, 2020.