ALBERT

Description: Estimates describing the survival and relapse risk for young classical Hodgkin lymphoma (cHL) patients are of considerable interest. A recent population-based study from British Columbia focused on the evolution of the relative survival and relapse risk given that patients reached certain milestones such as two years of relapse-free survival (Hapgood et al. 2016). The study included patients diagnosed before the year 2000 who were treated with regimens that have since been refined. Using register-data from Denmark, Sweden, and Norway, we investigated cHL survivorship in the era of contemporary treatment by inspecting the evolution of relapse risk and loss in life expectancy. Inclusion criteria were: age at diagnosis 18-49 years; diagnosis year between 2000 and 2013; and treatment with chemotherapy (CT) with or without involved node/field radiation therapy (RT). Event-free survival was measured as the time from diagnosis to progression, relapse, or death, whichever came first. The five-year relapse risks from diagnosis and conditional on reaching event-free survival (EFS) milestones were estimated while taking the censoring and competing risk, death, into account. As a measure of relative survival, we estimated the five-year restricted loss in expected lifetime (5y-RLEL), defined as the numeric difference in the number of days a healthy person and a patient with cHL are expected to survive within the next five years. The 5y-RLEL was estimated taking the censoring into account and was estimated for all patients and for those reaching one (EFS1), two (EFS2), or five (EFS5) years of event-free survival. In total, 2,582 cHL patients were included (Denmark n=863, Sweden n=1,236, Norway n=483). The majority were treated with ABVD (n=1,932). Most limited stage (IA-IIA) patients were treated with 2-4 courses of CT and RT with dosage up to 30Gy The majority of the advanced stage (IIB-IV) patients were treated with 6-8 courses of CT +/- RT. A fraction of the patients (n=306) were treated with 6-8 BEACOPP 14 or escalated BEACOPP. Advanced stage patients receiving BEACOPP more often had adverse risk criteria including involvement of the bone-marrow (27% vs 6%) and/or other extranodal sites (60% vs 34%) than advanced stage patients treated with 6-8 cycles of ABVD. The five-year OS was 95.2% (95% CI 94.4 - 96.1) and the five-year risk of relapse was 13.4% (95% CI 12.1-14.8). The dynamic evolution of the five-year relapse risk is shown in Figure 1A and the 5y-RLEL estimates in Figure 1B. For patients reaching the EFS2 and EFS5 milestones, five-year relapse risks were 4.2% (95% CI 3.8 - 4.6) and 0.8% (95% CI 0.8 - 0.9) (Figure 1A), respectively. From diagnosis, the five-year relapse risk for advanced stage patients was twice as high as for limited stage patients, however the difference decreased among patients reaching later EFS milestones and was small after EFS3 irrespective of stage (2.5% [95% CI 2.1 - 2.9] for advanced stage disease vs. 2.0% [95% CI 1.6 - 2.4] for limited stage disease) (Figure 1A). The five-year relapse risk for advanced stage patients treated with 6-8 courses of BEACOPP was comparable to that of advanced stage patients treated with 6-8 courses of ABVD despite more adverse risk criteria among the BEACOPP treated patients (Figure 1A). The 5y-RLEL was limited, e.g. within the first five years post-diagnosis the HL patients were expected to live 46 days (95% CI 35 - 54) less than what was expected for the background population (Figure 1B). Patients reaching the EFS2 milestone had a 5y-RLEL of 13 days (95% CI 7 - 20) and for patients reaching the EFS5 milestone, the 5y-RLEL was 8 days (95% CI 2 - 14) (Figure 1B). Limited stage patients who remained event-free two years post-diagnosis had a minimal 5y-RLEL of 2 days (95% CI -4 - 7) (Figure 1B). By reporting five-year relapse risk and loss of life expectancy overall and conditioned on years in remission, we provide relevant patient-centred prognostic measures for young contemporarily treated cHL patients. The results are reassuring and indicate that limited stage patients who remain event-free two years post-diagnosis have a future life expectancy in line with HL-free individuals. Additionally, irrespective of risk group, the five-year relapse risk was minimal once three years of event-free survival was reached. This information should be taken into account in future surveillance programs. Disclosures Eloranta: Janssen Pharmaceuticals: Other: S Eloranta is currently employed as a project coordinator and her salary is funded via a public-private real world evidence collaboration between Karolinska Institutet and Janssen Pharmaceuticals. Fosså:Janssen Pharmaceuticals, Inc.: Honoraria. Ekstroem Smedby:Janssen Pharmaceuticals: Other: The Department have recieved partial funding from Janssen Pharmaceuticals.

Description: Background: Non-endemic Burkitt lymphoma (BL) is a rare B-cell malignancy characterized by extreme tumor proliferation, frequent extranodal involvement, and the genetic hallmark of a MYC gene rearrangement. Despite an often dramatic initial presentation featuring tumor compression of vital organs and/or spontaneous tumor lysis syndrome, most patients who survive intensive immunochemotherapy induction are cured. Despite limited evidence of benefit, the current NCCN guidelines recommend that BL patients in CR are reviewed every 3 months for 2 years and every 6 months thereafter. Aims: To investigate outcomes, including relative survival and relapse risks conditional on event-free survival (EFS) milestones, in an international study of real-world BL patients treated with intensive immunochemotherapy. Patients and methods: This is a retrospective study of newly diagnosed BL patients identified from relevant population or hospital-based registers in Australia (Perth), Denmark (the Danish Lymphoma Registry), Sweden (the Swedish Lymphoma Registry) and Norway (Health Region South East). Patients who met the following criteria were included irrespective of HIV status: 1) age ≥18 years at diagnosis, 2) diagnosed during the period 2005-2017, 3) histology and immunohistochemistry consistent with BL, 4) MYC translocation detected by fluorescence in situ hybridization (FISH), and 5) intensive first line immunochemotherapy including rituximab (R-CHOEP or more intensive). Patient data were collected from registers and chart reviews. Overall survival (OS) was defined as time until death and EFS was defined as time to death, relapse/progression, or unplanned treatment, whichever came first. Prognostic features at baseline were evaluated using univariate Cox models with EFS as outcome. Standardized mortality ratios (SMRs), conditional relative survival estimates, and relapse risks were computed for the subset of patients achieving complete remission (CR or CRu), with follow-up measured from response evaluation and from different EFS milestones. Results: In total, 159 patients fulfilled the inclusion criteria of the study. The median age was 48 years (range 18-81) and the male:female ratio was 2.9. The baseline characteristics included stage III-IV (75%), elevated serum LDH (75%), extranodal involvement (83% - bone or bone marrow in 42% and CNS in 8%), B symptoms (60%), and ECOG performance score 〉1 (30%). The chemotherapy protocols used were CHOEP (2%), DA-EPOCH (13%), HYPER-CVAD (26%), CODOX-M/IVAC (28%), BFM or GMALL (31%), and others (1%). Clinical tumor lysis syndrome defined by severe electrolyte derangement, renal impairment, and/or cardiac arrhythmia, was noted in 16% of the patients, but no fatal episodes occurred. The overall response rate to first-line treatment was 88% (87% in CR/CRu) with 67% assessed by PET technology. The five-year EFS and OS estimates for the total population were 75% (95% CI 68-82%) and 82% (95% CI 76-88%), respectively, and the EFS and OS of patients

Description: Introduction: Non-endemic Burkitt lymphoma (BL) is a rare and highly aggressive B-cell malignancy, of whom a substantial number are adolescents and young adults (AYAs). In this particular group of patients, the balance between efficacy and long-term toxicities is of major concern, due to the long expected remaining lifetime. In this study, we investigated the outcomes for AYA patients treated with intensive immunochemotherapy. Patients and methods: Patients were identified through queries to clinic based and population-based lymphoma registries from six countries (Australia, Canada, Denmark, Norway, Sweden, and USA). All diagnoses were confirmed by local investigators; patients with classical BL histology plus detectable MYC translocation, were included. Patients between 18 and 39 years of age at diagnosis treated with intensive immunochemotherapy (DA-EPOCH-R or more intensively) were evaluated in pre-specified age groups. All treatment protocols included rituximab. Overall survival (OS) was defined as the time from diagnosis until death from any cause or censoring, while event-free survival (EFS) was defined as the time from diagnosis until unplanned re-treatment, progression/relapse, death, or censoring, whichever came first. Response evaluation was assessed using established response criteria based on CT and/or PET/CT imaging. Survival curves were computed using the Kaplan-Meier estimator. The cumulative incidence of relapse in patients reaching complete remission (CR) or CR unconfirmed (CRu) was computed by Aalen-Johansen estimator. The 5-year restricted loss of lifetime (RLOL) was defined as the area between the patient and general population survival curves until 5-years. The general population survival was retrieved from publicly available lifetables stratified on age, sex, calendar year, and country. Results: In total, 108 AYA BL patients were included. The median age was 30 years, ranging between 18 and 39 and 82% were male. The majority had advanced stage disease (Ann Arbor stage III-IV, 76%), extranodal involvement (87%), and elevated LDH (67%). Seven patients (6%) had CNS involvement at the time of diagnosis. The chemotherapy regimens used were CODOX-M/IVAC (51%), BFM/GMALL (34%), hyper-CVAD (7%), DA-EPOCH (5%), and others (3%). Among 74 patients for whom data on tumor lysis were available, 10 (14%) developed clinical tumor lysis upon start of chemotherapy, all presenting with advanced stage and extranodal disease. The response rate was 91% (89 in CR/CRu and 2% in partial remission). At a median follow-up of 53 months, 15 had an event and 10 died. The 2-year OS and EFS for the total population was 92% (87-97%, Figure 1) and 88% (82-94%), respectively. For 13 patients aged 18-21 2-year OS and EFS were both 100%, while 2-year OS and EFS for 43 patients aged 22-30 were 98% (93-100%) and 93% (85-100%), respectively. The 2-year OS and EFS for patients aged 31-39 were 86% (76-96%) and 80% (69-91%), respectively. For patients in CR/CRu and available date of response evaluation, the 2-year post-remission OS was 99% (97-100%) and the 2-year relapse risk was 2% (0-5%), with no relapses after 6 months. Compared to the general population, the RLOL was 0.8 months (-0.5-2.2 months). Nine patients did not respond to primary treatment (SD or PD), all which belonged to the age group 31-40 years (P

Description: Background. BL is a rare, high-grade B-cell lymphoma that is often studied in trials with small sample sizes. Historical definitions of "low-risk BL" vary between studies, use arbitrary cutoffs for lactate dehydrogenase (LDH), and identify a small favorable group, leaving 〉80-90% of patients (pts) in an undifferentiated "high-risk" category. A validated prognostic index will help compare study cohorts and better define good-prognosis pts for whom reduced treatment would be appropriate vs a poor-prognosis group in need of new approaches. Herein, we constructed and validated a simplified prognostic model for BL applicable to diverse clinical settings across the world. Methods. We derived the BL-IPI from a large real-world evidence cohort of US adults treated for BL in 2009-2018 (Evens A, Blood 2020). Progression-free survival (PFS) from diagnosis until BL recurrence, progression, death, or censoring was the primary outcome. We first determined the best prognostic cutoffs for age, LDH (normalized to local upper limit normal, ULN), hemoglobin (Hgb), and albumin. Independent risk factors were ascertained by forward stepwise selection into Cox regression from candidate variables: age, sex, HIV+ status, ECOG performance status (PS) ≥2, advanced stage (3/4), involvement of 〉1 extranodal site, bone marrow, central nervous system (CNS), values of LDH, Hgb, and albumin. Derivation models used multiple imputation to mitigate bias from missing data and reported hazard ratios (HR) with 95% confidence interval (CI). BL-IPI groups, defined by inspection of survival curves, were compared using log-rank test for trend. We validated performance of the BL-IPI in an external retrospective dataset of BL pts treated contemporaneously in centers from the United Kingdom, Scandinavia, Canada, and Australia. Results. Characteristics of pts in the derivation (N= 633) and validation (N=457) cohorts are shown in the Table. Age ≥40 years (yr), LDH 〉3xULN, Hgb 3xULN, PS ≥2, and CNS involvement were selected as 4 independent prognostic factors; adding stage did not enhance the model. The model was simplified to 3 groups with 0 (low risk; 18% of pts), 1 (intermediate risk; 36% of pts; HR=3.14; 95%CI, 1.61-6.14), or 2-4 factors (high risk; 46% of pts; HR=6.52; 95%CI, 3.48-12.20; Fig A) with 3 yr PFS of 92%, 72%, and 53%, respectively (P