The importance of early treatment to decrease therapy-related complications in Burkitt lymphoma (BL), Burkitt-like leukemia/lymphoma (BLL), and acute lymphocytic leukemia (ALL) treated with disease-specific systemic therapy.

Abstract

6577 Background: BL, BLL and ALL are highly aggressive malignancies. We conducted a study to determine the relationship between the time to start of disease-specific systemic therapy and the frequency of various complications during treatment. Methods: A multi-center chart review was conducted for a total of 175 patients (pts) from Cleveland Clinic and Beaumont Health System, who received thearapy between Jan 2000 and Oct 2012. Pts were classified into two groups based on time to start of disease-specific systemic therapy. The first group started therapy within 1 week of the presenting symptoms and the second group started therapy in ≥ 1 week. Pts characteristics, stage of disease, incidence of acute renal failure (ARF) [Am J Med. 1983;74(2):243], Tumor lysis syndrome (TLS) [Cairo-Bishop definition], major bleeding [requiring transfusion, drop in hemoglobin > 2 g/dL, or bleeding in critical sites], venous thrombotic events (VTEs) [documented by imaging], neutropenic fever (NF) [Clin Infect Dis. 2011;52(4):e56], and mortality rate were retrieved from the records. Results: Of 175 pts (66 BL, 13 BLL, 96 ALL), 67 % were males, 92.6 % had stages III or IV disease. Chi-Square test analysis showed pts treated with disease specific systemic therapy within 1 week as compared to those whose treatment began ≥ 1 week after symptoms onset had less incidence of ARF (16.7% vs 38.5% p=0.001), less TLS (3.6% vs 16.5% p=0.006), less VTEs (8.3% vs 16.6% p=0.007), less NF (3.6% vs 24.2% p=0.001) and most importantly had a lower mortality rate during the therapy (1.2% vs 8.8% p=0.036). Further analysis of the data showed no significant difference in the incidence of major bleeding between the two groups (9.5% vs 17.8 p=0.129), although there was a trend toward fewer episodes in pts started on therapy within 1 week. Conclusions: This study confirmed an increased risk of therapy related complications including higher mortality in pts with BL, BLL and ALL when the therapy was initiated ≥ 1 week after symptoms onset. These findings indicate that clinicians should start disease specific therapy within 1 week.