Low-Intensity Therapy in Adults with Burkitt's Lymphoma

Abstract

BACKGROUND Burkitt’s lymphoma is an aggressive B-cell lymphoma that occurs in children and adults and is largely curable with the use of intensive and toxic chemotherapy. Current treatments are less effective and have more severe side effects in adults and patients with immunodeficiency than in children. METHODS We studied low-intensity treatment consisting of infused etoposide, doxorubicin, and cyclophosphamide with vincristine, prednisone, and rituximab (EPOCH-R) in patients with untreated Burkitt’s lymphoma. Two EPOCH-R regimens were tested: a standard dose-adjusted combination in human immunodeficiency virus (HIV)–negative patients (DA-EPOCH-R group) and a lower-dose short-course combination with a double dose of rituximab in HIV-positive patients (SC-EPOCH-RR group). RESULTS A total of 30 consecutive patients were treated; 19 patients were in the DA-EPOCH-R group, and 11 in the SC-EPOCH-RR group. The overall median age of the patients was 33 years, and 40% were 40 years of age or older; 73% of the patients had intermediate-risk disease, and 10% had high-risk disease. The principal toxic events, fever and neutropenia, were observed during 22% of the DA-EPOCH-R treatment cycles and 10% of the SC-EPOCH-RR treatment cycles. The tumor lysis syndrome developed in 1 patient; no treatment-related deaths occurred. The median cumulative doses of doxorubicin–etoposide and cyclophosphamide administered in the SC-EPOCH-RR group were 47% and 57% lower, respectively, than those administered in the DA-EPOCH-R group. With median follow-up times of 86 months in the DA-EPOCH-R group and 73 months in the SC-EPOCH-RR group, the rates of freedom from progression of disease and overall survival were, respectively, 95% and 100% with DA-EPOCH-R and 100% and 90% with SC-EPOCH-RR. None of the patients died from Burkitt’s lymphoma. CONCLUSIONS In this uncontrolled prospective study, low-intensity EPOCH-R–based treatment was highly effective in adults with sporadic or immunodeficiency-associated Burkitt’s lymphoma. (Funded by the National Cancer Institute; ClinicalTrials.gov numbers, NCT00001337 and NCT00006436.)

A new prognostic score for AIDS-related lymphomas in the rituximab-era

“…BL requires more intensive chemotherapy, which, while feasible, may be less well tolerated by HIV-infected patients. [7][8][9][10] Second, rituximab has been associated with an increased risk of infectious deaths in patients with ARL and low base-line CD4 counts. 11 Third, HIV infection is a competing risk that may influence prognosis, and may be dependent not only on the base-line CD4 count, but also on other factors.…”

Phase II trial of dose-adjusted EPOCH in untreated systemic anaplastic large cell lymphoma

“…[4][5][6] Based on the efficacy of infusional DA-EPOCH in aggressive B-cell lymphomas, we investigated its activity in adults with ALK positive and negative ALCL. [7][8][9] In a previous short report, we had investigated serum soluble interleukin-2 levels in response to treatment in 9 patients with ALCL. Twenty-four patients with newly diagnosed ALCL were prospectively enrolled on a study of DA-EPOCH between September 1993 and December 2009.…”

Double-hit lymphomas: current paradigms and novel treatment approaches

“…CHOP-like therapy has low efficacy in DLBCL tumors with high proliferation and in Burkitt lymphoma. 30,31 Because DA-EPOCH-R is very effective in Burkitt lymphoma and in GCB-DLBCL cases with high tumor proliferation, the prognostic role of a MYC rearrangement was retrospectively assessed in a National Cancer Institute (NCI) and Cancer and Leukemia Group B (CALGB) study. 20 Of 59 DLBCL cases treated with the regimen, MYC rearrangements were detected in 10% and clinical and IPI characteristics were similar in both the MYC-rearranged and MYC-negative groups.…”