Treatment of Burkitt Lymphoma/Leukemia (BL/L) in adults has evolved from the use of pediatric inspired regimens (CODOX-M/IVAC, hyper-CVAD, GMALL) to the use of lower intensity EPOCH regimens. The addition of rituximab has led to improvements in overall survival. Survival with these regimens in the real world was shown to be inferior as compared to those found in the prospective trials. In low- and middle-income country (LMIC) settings, unique problems like delays in seeking care, treatment-related toxicities, and treatment abandonment may hamper outcomes. We performed this retrospective multicenter analysis amongst eight centers in India, to study the disease characteristics, treatment patterns, outcomes, and prognostic factors for BL/L. Between 2012–2019, 265 patients were treated at these centers. Common regimens were methotrexate-based (N – 108(40.7%)) and EPOCH-based (N – 103(38.8%)). After a median follow-up of 42 months, 3-year event-free and overall survival were 58% (95% CI: 55–61%) and 66% (95%CI: 63–69%) respectively. In a propensity matched analysis comparing methotrexate-based protocol and EPOCH-based protocol, the EFS and OS were similar with both the protocols. EPOCH based protocol yielded inferior outcomes in patients with bone marrow, and central nervous system involvement. Factors like rituximab incorporation, baseline ECOG PS 0–2, lower serum LDH, early stage(I/II), achievement of complete response (CR) and low/intermediate BL-IPI risk scores were associated with better survival. However, on multivariable analysis, major factor impacting outcome was achievement of CR.
成人伯基特淋巴瘤/白血病（BL/L）的治疗模式已从儿童方案启发（CODOX-M/IVAC、hyper-CVAD、GMALL）演变为低强度EPOCH方案的应用。利妥昔单抗的加入改善了患者总生存期。现实世界中这些方案的生存结果较前瞻性试验数据有所差距。在中低收入国家（LMIC）环境下，就医延迟、治疗相关毒性和放弃治疗等特殊问题可能影响疗效。我们在印度八家中心开展了一项回顾性多中心分析，以研究BL/L的疾病特征、治疗模式、疗效及预后因素。2012年至2019年间，这些中心共收治265例患者。常用方案包括基于甲氨蝶呤的方案（108例，占40.7%）和基于EPOCH的方案（103例，占38.8%）。中位随访42个月后，3年无事件生存率和总生存率分别为58%（95% CI：55–61%）和66%（95% CI：63–69%）。在甲氨蝶呤方案与EPOCH方案的倾向评分匹配分析中，两者的无事件生存率和总生存率相近。对于合并骨髓及中枢神经系统受累的患者，EPOCH方案疗效较差。利妥昔单抗的使用、基线ECOG PS 0–2分、较低血清LDH水平、早期（I/II期）、达到完全缓解（CR）以及低/中危BL-IPI评分等因素与更好生存率相关。然而，在多变量分析中，影响疗效的主要因素是达到完全缓解。
肿瘤(癌症)患者之家