Treatment of Burkitt's lymphoma in HIV-positive patients

Dj, Straus

doi:10.1016/s0753-3322(97)86004-0

Cited by 22 publications

(20 citation statements)

References 24 publications

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“…37 The relatively good immune function possessed by patients with HIV-associated BL (independent of HAART) further suggests that this subset of patients may benefit from aggressive chemotherapy regimens that have acceptable toxicities. 6,27,28,31 Cortes et al 38 recently reported a retrospective study of 13 HIV-positive adult patients with BL who received intensive chemotherapy with hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone (hyper CVAD) alternating with high dose methatrexate and Ara-C from 1995 to 2000. Although they demonstrated an overall response rate of 92%, the median survival period was only 12 months.…”

Section: Table 4 Grade Iii/iv Toxicities Following Codox-m/ivac Chemomentioning

confidence: 99%

“…It has been proposed that HIV-positive patients with BL and preserved immune function may represent a subset of patients with acquired immunodeficiency syndrome (AIDS)-related lymphoma who would benefit from more aggressive chemotherapeutic approaches with acceptable toxicities. 6 However, because of the perceived risk of increased hematologic and infectious complications, most patients with HIVassociated BL continue to be treated with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) and other moderate-dose chemotherapy regimens, despite the fact that such treatment is known to be inferior to intensive chemotherapy in HIV-negative patients with BL.…”

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confidence: 99%

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Intensive chemotherapy with cyclophosphamide, doxorubicin, high‐dose methotrexate/ifosfamide, etoposide, and high‐dose cytarabine (CODOX‐M/IVAC) for human immunodeficiency virus–associated Burkitt lymphoma

Wang

Straus

Teruya‐Feldstein

et al. 2003

Cancer

147

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BACKGROUNDIn the era of highly active antiretroviral therapy (HAART), standard‐dose chemotherapy for human immunodeficiency virus (HIV)‐associated diffuse large B‐cell lymphoma is becoming the standard of care. In contrast, the safety and efficacy of intensive regimens have not been established for Burkitt lymphoma (BL), a highly aggressive lymphoma for which moderate‐dose chemotherapy is substandard in the HIV‐negative population.METHODSTo evaluate the feasibility of intensive chemotherapy in HIV‐associated BL, the authors retrospectively reviewed 14 HIV‐positive adults with BL treated at their center between 1988 and 2000. Eight patients were treated between 1996 and 2000 with cyclophosphamide, doxorubicin, high‐dose methotrexate/ifosfamide, etoposide, and high‐dose cytarabine (CODOX‐M/IVAC), one of the currently preferred intensive‐dose chemotherapy regimens for BL. Six received other chemotherapy. Outcomes were compared with those of 24 HIV‐negative adult patients with BL who had similar patient characteristics and were treated concomitantly (13 with CODOX‐M/IVAC; 11 with other regimens).RESULTSOf the 14 HIV‐positive patients, 63% had a complete response after CODOX‐M/IVAC treatment, compared with 67% of patients receiving other chemotherapy. The 2‐year event‐free survival (EFS) rates were 60% and 60% after CODOX‐M/IVAC or other regimens, respectively. Similar outcomes were seen despite the fact that 88% of CODOX‐M/IVAC‐treated HIV‐positive patients had Stage IV disease, compared with one‐third of HIV‐positive patients treated with other chemotherapy. HIV status did not adversely affect long‐term EFS independent of the treatment regimen (P = 0.88). When EFS was evaluated according to chemotherapy regimen independent of HIV status, CODOX‐M/IVAC was found to be associated with improved EFS (P = 0.05) in all patients, and particularly those at high risk. HIV‐positive patients treated with CODOX‐M/IVAC tolerated chemotherapy well with similar rates of myelosuppression and infectious complications as HIV‐negative patients.CONCLUSIONSThe current nonrandomized retrospective study suggested that intensive chemotherapy with CODOX‐M/IVAC is feasible and well tolerated in HIV‐positive adults with BL. In the post‐HAART era, intensive chemotherapy such as CODOX‐M/IVAC may be appropriate in all adult patients with BL, and especially those with poor prognostic factors, regardless of HIV status. Cancer 2003;98:1196–205. © 2003 American Cancer Society.DOI 10.1002/cncr.11628

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Section: Table 4 Grade Iii/iv Toxicities Following Codox-m/ivac Chemomentioning

confidence: 99%

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confidence: 99%

Intensive chemotherapy with cyclophosphamide, doxorubicin, high‐dose methotrexate/ifosfamide, etoposide, and high‐dose cytarabine (CODOX‐M/IVAC) for human immunodeficiency virus–associated Burkitt lymphoma

Wang

Straus

Teruya‐Feldstein

et al. 2003

Cancer

147

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“…However, only 20% of patients with bone marrow or CNS involvement achieved durable responses. [3][4][5] In 1996, Magrath et al 6 reported a 92% 2-year event-free survival (EFS) rate in HIV-negative adult and pediatric patients after intensive chemotherapy with cyclophosphamide, vincristine, doxorubicin, high-dose methotrexate/ifosfamide, etoposide, and high-dose cytarabine (CODOX-M/IVAC). Results were particularly impressive in patients with bone marrow and/or CNS involvement, with an 80% 2-year disease-free survival rate.…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, HIV-positive patients with BL and preserved immune function may benefit from more aggressive chemotherapeutic approaches with acceptable toxicities. 3 Finally, retrospective analyses suggest that HAART era HIV-positive BL patients do poorly with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) -like regimens, 17 but may do well with intensive regimens. 18 Nonetheless, because of the perceived risk of increased hematologic and infectious complications, many patients with HIV-associated BL continue to be treated with CHOP and other moderate-dose chemotherapy despite inferiority in HIV-negative BL patients.…”

Section: Introductionmentioning

confidence: 99%

AMC 048: modified CODOX-M/IVAC-rituximab is safe and effective for HIV-associated Burkitt lymphoma

Noy

Lee

Cesarman

et al. 2015

Blood

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• We report the first dedicated prospective study in HIV-Burkitt lymphoma demonstrating safety and efficacy in a multiinstitutional setting.• We offer a new therapeutic option by modifying an existing regimen and making it much less toxic.The toxicity of dose-intensive regimens used for Burkitt lymphoma prompted modification of cyclophosphamide, vincristine, doxorubicin, high-dose methotrexate/ifosfamide, etoposide, and high-dose cytarabine (CODOX-M/IVAC) for HIV-positive patients. We added rituximab, reduced and/or rescheduled cyclophosphamide and methotrexate, capped vincristine, and used combination intrathecal chemotherapy. Antibiotic prophylaxis and growth factor support were required; highly active antiretroviral therapy (HAART) was discretionary. Thirteen AIDS Malignancy Consortium centers enrolled 34 patients from 2007 to 2010. Median age was 42 years (range, 19-55 years), 32 of 34 patients were high risk, 74% had stage III to IV BL and CD4 count of 195 cells per mL (range, 0-721 cells per mL), and 5 patients (15%) had CD4 <100 cells per mL. Twenty-six patients were receiving HAART; viral load was <100 copies per mL in 12 patients. Twenty-seven patients had at least one grade 3 to 5 toxicity, including 20 hematologic, 14 infectious, and 6 metabolic. None had grade 3 to 4 mucositis. Five patients did not complete treatments because of adverse events. Eleven patients died, including 1 treatment-related and 8 disease-related deaths. The 1-year progressionfree survival was 69% (95% confidence interval [CI], 51%-82%) and overall survival was 72% (95% CI, 53%-84%); 2-year overall survival was 69% (95% CI, 50%-82%). Modifications of the CODOX-M/IVAC regimen resulted in a grade 3 to 4 toxicity rate of 79%, which was lower than that in the parent regimen (100%), without grade 3 to 4 mucositis. Despite a 68% protocol completion rate, the 1-year survival rate compares favorably with 2 studies that excluded HIV-positive patients. This trial was registered at http:// clinicaltrials.gov as #NCT00392834. (Blood. 2015;126(2):160-166)

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“…Burkitt's lymphoma (BL) represents 25 to 40% of HIVassociated lymphomas [5]. The decrease in the incidence of BL in the era of HAART has been less marked than that seen with other lymphoma subtypes [6].…”

Section: Discussionmentioning

confidence: 99%

Successful administration of aggressive chemotherapy concomitant to tuberculostatic and highly active antiretroviral therapy in a patient with AIDS‐related Burkitt's lymphoma

et al. 2005

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Treatment of AIDS‐related malignant lymphoma (ARL) remains a therapeutic challenge. There are concerns not only about infectious and haematological complications in HIV‐infected patients during intensive chemotherapy, but also about potential interactions between chemotherapy and highly active antiretroviral therapy (HAART). Current data on patients treated concomitantly with intensive chemotherapy and HAART are limited, and no data exist on patients with ARL suffering from active opportunistic infections. We report the case of a 38‐year‐old man with advanced HIV‐1 infection, pulmonary tuberculosis and Burkitt's lymphoma. Intensive chemotherapy was administered in parallel with tuberculostatic therapy and HAART. Six months later, the patient achieved not only a complete remission of Burkitt's lymphoma and sustained viral suppression, but also a full recovery from tuberculosis. This case report provides some useful observations on the successful application of intensive chemotherapy in addition to tuberculostatic therapy and HAART in HIV‐infected patients.

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Treatment of Burkitt's lymphoma in HIV-positive patients

Cited by 22 publications

References 24 publications

Intensive chemotherapy with cyclophosphamide, doxorubicin, high‐dose methotrexate/ifosfamide, etoposide, and high‐dose cytarabine (CODOX‐M/IVAC) for human immunodeficiency virus–associated Burkitt lymphoma

Intensive chemotherapy with cyclophosphamide, doxorubicin, high‐dose methotrexate/ifosfamide, etoposide, and high‐dose cytarabine (CODOX‐M/IVAC) for human immunodeficiency virus–associated Burkitt lymphoma

AMC 048: modified CODOX-M/IVAC-rituximab is safe and effective for HIV-associated Burkitt lymphoma

Successful administration of aggressive chemotherapy concomitant to tuberculostatic and highly active antiretroviral therapy in a patient with AIDS‐related Burkitt's lymphoma

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