In our study, the median age of patients was 40 years (range: 21 to 72 years). The majority of patients were male (87.8%) and most were in the advanced stage (75.6%). Nearly half of the patients had bone marrow involvement, and 19.5% had central nervous system involvement. 48.8% (20/41) of patients had 3x elevated serum lactate dehydrogenase (LDH) levels. 24.4%of patients had extranodal involvement. Additionally, the median CD4 count was calculated as 245 cells/μl (range: 9 to 729 cells/μl). According to the BL-IPI score, 29.2% of patients in this cohort were classified as high risk. Table 1 provides detailed information on their clinical characteristics.

58.5% of patients received chemotherapy based on rituximab. The most commonly used chemotherapy regimen was DA-EPOCH ± R (53.6%), which included R-DA-EPOCH (29.3%) and DA-EPOCH (24.3%). Only one patient received the CODOX-M/IVAC treatment regimen. The overall response rate (ORR) to first-line treatment in the entire cohort was 53.7%, with a complete response rate (CR) of 24.3% and a partial response rate (PR) of 29.2%. The CR and PR rates for patients receiving the DA-EPOCH ± R regimen were 36.3% and 22.7% respectively, while the CR and PR rates for patients receiving the R-Hyper-CVAD/MA regimen were 16.6% and 41.6% respectively. The complete response rate for patients receiving rituximab-containing regimens was similar to that of patients not receiving rituximab (25% vs. 23.5%). Only 4 patients (9.7%) underwent hematopoietic stem cell transplantation.

Only 11 patients (11/41, 26.8%) received systemic methotrexate and cytarabine therapy, while 30 patients (30/41, 73.2%) received intrathecal injections as central nervous system prophylaxis. Among the 8 HIV-associated Burkitt lymphoma patients with central nervous system involvement at initial diagnosis, one achieved complete remission after 4 cycles of EPOCH treatment, but later experienced rapid disease progression.

Additionally, 41% of patients experienced disease progression. Patients treated with rituximab had a lower risk of disease progression compared to those not treated with rituximab (33.3% vs. 47.1%). Among patients treated with the DA-EPOCH ± R regimen, 36.4% (8/22) experienced disease progression, while 41.7% (5/12) of patients treated with the R-Hyper-CVAD/MA regimen experienced disease progression.

In this study, 17.1% (7/41) of patients were lost to follow-up. The median follow-up period was 10.9 months (range 0.3–99 months). At the last follow-up, 46.3% (19/41) of HIV-associated Burkitt lymphoma patients had died. Disease progression was the main cause of death (8/19, 42.1%), followed by infection (7/19, 36.8%). The 1-year progression-free survival rate and overall survival rate for the entire cohort were 52% and 67% respectively (Fig. 1). According to the Burkitt lymphoma International Prognostic Index (BL-IPI) score, the 1-year overall survival rates for the low-risk, intermediate-risk, and high-risk groups were 75%, 62%, and 40% respectively (Fig. 2A). Additionally, the 1-year progression-free survival rates for the low-risk, intermediate-risk, and high-risk groups were 67%, 55%, and 39% respectively (Fig. 2B). The choice of first-line treatment (based on the DA-EPOCH regimen or R-Hyper-CVAD/MA regimen) did not significantly affect survival outcomes, whether in terms of overall survival (P = 0.821) or progression-free survival (P = 0.789).

Overall survival (A) and progression-free survival (B) for patients with HIV-associated Burkitt lymphoma

The prognosis of patients with HIV-associated Burkitt lymphoma. The overall survival (A) and progression-free survival (B) of low-, intermediate- and high-risk subgroups. The overall survival (C) and progression-free survival (D) of central nervous system involvement. The overall survival (E) and progression-free survival (F) of patients with LDH > 3x ULN. ULN, upper limit of normal

Table 2 shows the results of the univariate and multivariate analyses in HIV-associated Burkitt lymphoma patients. Both the univariate and multivariate analyses showed a significant association between LDH level, central nervous system (CNS) involvement, and survival. However, in multivariate analysis, only CNS involvement was identified as an independent risk factor for predicting progression-free survival in HIV-associated Burkitt lymphoma patients. The 1-year overall survival rate and progression-free survival rate for patients with CNS involvement were 38% and 0%, respectively, compared to 75% and 66% for those without involvement (Fig. 2C-D). The 1-year overall survival rate for patients with LDH levels exceeding the upper limit of normal (ULN) threefold was 50%, while those without this condition had a rate of 84% (Fig. 2E). The 1-year progression-free survival rate for patients with LDH levels exceeding the ULN threefold was 41%, while those without this condition had a rate of 63% (Fig. 2F). In addition, the analysis of overall survival time with or without rituximab showed no significant difference, with durations of 45.69 ± 11.58 and 47.79 ± 11.72, respectively (P = 0.907).

During the follow-up period, all 8 patients with CNS involvement died. Subsequently, the clinical characteristics of patients with CNS involvement were analyzed. Patients with CNS involvement were more likely to have concurrent B symptoms (100% versus 54.5%, P = 0.018) and higher ECOG scores (87.5% versus 27.3%, P = 0.003) compared to patients without CNS involvement. The differences in clinical characteristics between the two subgroups are detailed in Table 3.