Risk-Adapted Therapy in Adults with Burkitt Lymphoma: Preliminary Report of a Multicenter Prospective Phase II Study of DA-EPOCH-R
Authors: Dunleavy Kieron , Noy Ariela , Abramson Jeremy S. , LaCasce Ann S. , Link Brian K , Parekh Samir , Jagadeesh Deepa , Bierman Philip J , Mitsuyasu Ronald T. , Battini Ramakrishna , Watson Peter R , Peace David , Averbrook Bruce J , Naina Harris V. , Leach Joseph W , Hanna Wahid T , Powell Bayard L. , Nagpal Sunil , Roschewski Mark , Lucas Andrea N , Steinberg Seth M. , Kahl Brad S , Friedberg Jonathan W. , Little Richard F , Bartlett Nancy L , Fanale Michelle A. , Wilson Wyndham H 
Published: October 2019

Abstract
Background: Burkitt lymphoma (BL) is a highly aggressive B-cell lymphoma that is largely curable with intensive therapy. Previously, a single-center study of 30 patients demonstrated that DA-EPOCH-R based therapy was highly effective in adults with BL (N Engl J Med 2013; 369:1915-1925). We set out to validate these results in a multi-center study and assess if a risk-adapted approach using DA-EPOCH-R is effective.
Methods: Patients had newly diagnosed BL, age 18 years or older and HIV negative or positive. Low-risk (LR) patients (normal LDH, ECOG P.S. 0-1, stage I or II disease and a maximum tumor size < 7cm) received 3 cycles of DA-EPOCH-R (with no intrathecal prophylaxis) and all other patients (classified as high risk (HR)) received 6 cycles (with IT prophylaxis days 1 and 5 on cycles 3-6).
Results: 77 patients were enrolled. Characteristics include median (range) age 45 (19-78) years; male sex 63 (82%); stage III or IV disease 49 (64%); elevated LDH 41 (53%); CNS involvement 7 (10%); HIV positive 20 (26%). Eleven (14%) and 66 (86%) were classified as LR and HR respectively. There were 2 deaths on treatment in the HR arm secondary to infection. Other toxicities were similar to previous reports of DA-EPOCH-R. At a median follow-up time of 25 months, time to progression (TTP), progression-free survival (PFS) and overall survival (OS) were 92% (95% CI: 82.9-96.8%), 87% (95% CI: 76.2-93%) and 88% (95% CI: 77.1-93.8%) respectively for all patients. TTP, PFS and OS were not significantly different for HR versus LR disease, HIV positive versus negative and age over versus under 40y.
Conclusions: In a multicenter setting, both LR and HR patients have excellent outcomes with 3 and 6 cycles of therapy respectively. Risk group, HIV status and age are not associated with outcome (see table). Accrual to this study continues (NCT01092182).
Table. TTP PFS OS Patients N=77 92% 87% 88% LR HR p 11 66 100% 91% 0.35 100% 85%0.22 100% 86%0.24 HIV - HIV + p 57 20 96% 84% 0.1 88% 84%0.66 90% 83%0.53 Age under 40 Age over 40 p 35 42 94% 91% 0.83 90% 84% 0.45 93% 83%0.24
Figure 1. Figure 1.

Disclosures
Link: Genentech: Consultancy, Research Funding; Kite Pharma: Research Funding. Kahl:Roche/Genentech: Consultancy; Seattle Genetics: Consultancy; Millennium: Consultancy; Cell Therapeutics: Consultancy; Celgene: Consultancy; Infinity: Consultancy; Pharmacyclics: Consultancy; Juno: Consultancy. Bartlett:Gilead: Consultancy, Research Funding; Janssen: Research Funding; Pharmacyclics: Research Funding; Genentech: Research Funding; Pfizer: Research Funding; Novartis: Research Funding; Millennium: Research Funding; Colgene: Research Funding; Medimmune: Research Funding; Kite: Research Funding; Insight: Research Funding; Seattle Genetics: Consultancy, Research Funding; MERC: Research Funding; Dynavax: Research Funding; Idera: Research Funding; Portola: Research Funding; Bristol Meyers Squibb: Research Funding; Infinity: Research Funding; LAM Theapeutics: Research Funding.