A new study that tracked survival during the last decade of more than 2,200 adults with a highly aggressive form of lymphoma has found that medicine has made substantial progress in treating them successfully, with notable exceptions. The study authors created a stratified risk score of patient prognosis to help doctors and researchers understand who does and who does not respond well to treatment.
Burkitt lymphoma is not a common lymphoma, but it is especially aggressive. The progress doctors have made during the last two decades has come, unlike with many other cancers, with little guidance about how to treat different patients or what outcomes to expect. The same regimen of intensive chemotherapy and the monoclonal antibody rituximab are recommended for most patients.
“There was little available for Burkitt lymphoma in terms of prognostic factors, indicators, or scoring,” said Jorge Castillo, MD, an assistant professor of medicine at the Warren Alpert Medical School of Brown University and a hematology/oncology specialist at Rhode Island Hospital, in Providence. He is the lead author of the study, which first appeared online July 30, 2013, in Cancer (2013; doi:10.1002/cncr.28264).
Using 11 years of patient records in the Surveillance, Epidemiology, and End Results (SEER) database, survival rates were analyzed among 2,284 patients by factors that included age, race, stage of cancer at diagnosis, and in what region of the body the cancer struck.
While survival rates have risen substantially overall, outcomes have not improved much for patients who are older than 60 years, black, or whose cancer is diagnosed at a late stage. The researchers used these risk factors to create a simple new score that allowed them to make meaningful distinctions about prognosis. Patients with the lowest score have a better than 70% chance of survival with treatment, while those with the highest score have a less than 30% chance of surviving.
Castillo and his coauthors found that patients older than 80 years have nearly five times the risk for dying from the cancer as people aged 20 to 39 years. Patients aged 60 to 79 years had twice the risk of dying as the youngest patients, and those aged 40 to 59 years had a risk 1.5 times greater than those aged 20 to 39 years.
Risk of death climbed similarly with the stage of cancer. Stage IV patients had a 2.4 times greater risk of dying than those at Stage I. Stage III patients had a 1.5 times greater risk.
Race was also a factor, although to a lesser degree. Hispanics and whites had similar risk levels but black people, who accounted for 9.3% of the patients, had a 1.6 times higher risk of death.
The score that the researchers developed can help doctors, patients, and their families understand what to expect and to evaluate if intensive regimens of difficult therapy are truly desirable.