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Vol. 27, Art. 22 (pp. 534-554) | 2026
Analysis of mortality in hiv-positive patients with Burkitt's lymphoma
Ogannisyan A.A., Mabudzade Ch.K., Dudina G.A.
Moscow Clinical Scientific Center named after Loginov MHD, Build. 6, 86 Enthusiasts Highway, Moscow, 111123, Russian Federation
Brief summary
Burkitt's lymphoma (BL) is one of the most aggressive B-cell tumors requiring intensive polychemotherapy within a compressed timeframe. Prolonged myelosuppression, inevitably accompanying such treatment, creates a high risk of life-threatening infectious complications, especially in patients with pre-existing immunodeficiency. For a long time, HIV-positive status was considered a factor limiting the possibility of full-dose antitumor therapy for BL due to disproportionately high infection-related mortality. Objectives. The objective of the study was to perform a comparative analysis of the frequency, structure, and severity of hematological and non-hematological toxicity, as well as the causes of mortality in patients with Burkitt's lymphoma (BL), depending on HIV status and treatment period. Materials and Methods. A retrospective cohort study included 93 patients with verified BL. All patients were divided into four groups: HIV-negative (2001-2020, n=32), HIV-positive (2001-2020, n=28), HIV-negative (2020-2025, n=16), and HIV-positive (2020-2025, n=17). Toxicity was assessed according to CTCAE v5.0, and the mortality structure was analyzed. Results. In the modern cohort (2020-2025), a reduction in the duration of agranulocytosis from 8.9 to 4.5 days (p<0.001), the incidence of febrile neutropenia from 45.2% to 12.8% (p<0.001), and invasive mycoses from 18.3% to 4.2% (p<0.01) was observed. Among HIV-positive patients, the proportion of infection-related mortality decreased from 91.7% to 50.0% (p<0.01). Objective changes in the causes of death were noted: a shift from dominance of infectious complications to lymphoma progression as the main cause of death (60-80% of fatal outcomes). Conclusions. The implementation of primary G-CSF prophylaxis (100% coverage), extended-spectrum antifungals (voriconazole/posaconazole), and optimized integrase inhibitor-based ART has led to a dramatic reduction in infection-related mortality, particularly among HIV-positive patients. HIV status has ceased to be a limiting factor for delivering intensive chemotherapy in BL. Key words Burkitt's lymphoma; toxicity; tumor lysis syndrome; HIV infection; mortality; antifungal prophylaxis (The article in PDF format. For preview need Adobe Acrobat Reader)  Open article in new window
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