A novel prognostic index for sporadic Burkitt lymphoma in adult patients: A real-word multicenter study

Adult sporadic Burkitt lymphoma (BL) is a rare but highly aggressive subtype of lymphoma which lacks its own unique prognostic model. Systemic inflammatory biomarkers have been confirmed as prognostic markers in several types of malignancy. Our objective was to explore the predictive value of pretreatment inflammatory biomarkers and establish a novel, clinically applicable prognostic index for adult patients with sporadic BL.
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A novel prognostic index for sporadic Burkitt lymphoma in adult patients: A real-word multicenter studyChenetal. BMC Cancer (2022) 22:45https://doi.org/10.1186/s12885-021-09144-1 RESEARCH Open AccessA novel prognostic index forsporadicBurkitt lymphoma inadult patients: areal-wordmulticenter studyMei‑tingChen1†, FeiPan1†, Yung‑changChen2†, WeiZhang2†, Hui‑juanLv3†, ZhaoWang1, Huang‑mingHong2,Xiao‑jieFang1, Ya‑wenWang4, TaoPan5, Li‑qunZou6, Hong‑qiangGuo7, KeXie8, Li‑minChen1, Xiao‑qianLi1,Yu‑yiYao1, Ze‑gengChen1, Hua‑weiWeng1, Xu‑dongLi2, Yuan‑yuanShen2, HuiZhou5, Hong‑weiXue4,Hui‑laiZhang3, HeHuang1*and Tong‑yuLin1,2*  Abstract  Background:  Adult sporadic Burkitt lymphoma (BL) is a rare but highly aggressive subtype of lymphoma which lacks its own unique prognostic model. Systemic inflammatory biomarkers have been confirmed as prognostic markers in several types of malignancy. Our objective was to explore the predictive value of pretreatment inflammatory biomark‑ ers and establish a novel, clinically applicable prognostic index for adult patients with sporadic BL. Methods:  We surveyed retrospectively 336 adult patients with newly diagnosed sporadic BL at 8 Chinese medical centers and divided into training cohort (n = 229) and validation cohort (n = 107). The pretreatment inflammatory biomarkers were calculated for optimal cut-off value. The association between serum biomarkers and overall survival (OS) was analyzed by Kaplan–Meier curves and Cox proportional models. The risk stratification was defined based on normal LDH level, Ann Arbor stage of I and completely resected abdominal lesion or single extra-abdominal mass Chenetal. BMC Cancer (2022) 22:45 Page 2 of 11associated with malaria and Epstein-Barr virus (EBV) [4]. training cohort. Eligible patients had histologically con-The immunodeficiency-related variant has close relation- firmed sporadic BL according to the 2008 World Healthship with human immunodeficiency virus (HIV) [5]. Spo- Organization (WHO) criteria, and complete clinical, lab-radic BL is typically seen in young patients, but accounts oratory, and follow-up data. All patients were confirmedfor approximately 1% of adult NHLs [6]. diagnosed of BL by experienced pathologists. In order With intense chemotherapy treatment, disease progno- to avoid inclusion of high levels of B-cell lymphoma, allsis is excellent in children but poor in adults [7]. Acute cases had been detected by fluorescence insitu hybridi-treatment-related toxicity, such as severe myelosuppres- zation for c-Myc, Bcl-2, and Bcl-6. Evaluation includedsion, is an important factor affecting treatment outcomes standard laboratory tests, 18F-labeled fluorodeoxyglu-in adults [8]. Mark Roschewski et al. demonstrated cose positron emission tomography (18F-FDG PET)-that dose-adjusted etoposide, doxorubicin, cyclophos- computed tomography (CT) scans of the whole body,phamide, vincristine, prednisone, and rituximab (DA- and bone marrow aspiration and biopsy. Their medicalEPOCH-R) could avoid the need for high-dose intensive records were analyzed, a prognostic model for sporadicchemotherapy in adults with BL [9]. The International BL was constructed, and we validated the results in a val-Prognostic Index (IPI) is frequently used for prognosti- idation cohort. The validation cohort was retrospectivelycation in many aggressive lymphomas, but is not com- recruited from Tianjin Medical University Cancer Insti-monly used in BL [10]. According to the Murphy staging tute, Affiliated Hospital of Qingdao University, Henansystem, childhood BL can be staged and classified as low Cancer Hospital and Hunan Cancer Hospital in China.or high risk based on the number of involved sites, pres- The study protocol was approved by the ethical commit-ence of bulky disease, and lactate dehydrogenase (LDH) tee of Sun Yat-sen University Cancer Center (approval[11]. However, there is no standardized prognostic model number SZR2019–016). Informed consent was notfor adult BL. Recently, in a multicenter real-world study required because this study was a retrospective reportin Western countries presented that ages≥40, Eastern of cases, which is a retrospective analysis of clinical dataCooperative Oncology Group (ECOG) performance sta- with no relevant to human biological ethic problems. Thetus (PS) ≥ 2, LDH 3 times more than the upper normal need of informed consent was waived by the ethical com-limit and central nervous system (C ...