Less toxic treatment regimen effective for adults with untreated Burkitt lymphoma
Risk-adapted therapy with a dose-adjusted treatment regimen appeared effective and safe for adults with Burkitt lymphoma regardless of age or HIV status, according to results of a prospective study published in Journal of Clinical Oncology.
“We know that Burkitt lymphoma is curable with dose-intensive chemotherapy, but that treatment can be acutely toxic for adult patients,” Mark Roschewski, MD, clinical director of NCI’s lymphoid malignancies branch, said in a press release. “With this finding, we not only have a potentially curative treatment option for these patients that’s less toxic, but one that appears effective for most adults, including elderly patients and those with HIV and other comorbidities who might not be able to receive standard treatment.”
Burkitt lymphoma, an aggressive B-cell lymphoma, can be cured with dose-intensive chemotherapy derived from pediatric leukemia regimens. However, this treatment is acutely toxic, particularly for older adults and those with HIV infection.
Roschewski and colleagues assigned 113 adults (median age, 49 years; range, 18-86) with untreated Burkitt lymphoma to risk-adapted therapy with dose-adjusted etoposide, doxorubicin, cyclophosphamide, vincristine, prednisone and rituximab (Rituxan; Genentech, Biogen) to determine if this regimen, DA-EPOCH-R, could eliminate the need for high dose-intensive chemotherapy.
Most patients (87%) had high-risk disease, 25% were HIV-positive, and 26% had bone marrow or cerebrospinal fluid involvement.
EFS served as the primary endpoint. Toxicity and predictors of EFS and OS served as secondary endpoints.
Median follow-up was 58.7 months.
Results showed a 4-year EFS rate of 84.5% (95% CI, 76-90) and a 4-year OS rate of 87% (95% CI, 79-92).
All patients with low-risk disease achieved remission, compared with an EFS rate of 82.1% (95% CI, 73-89) and OS rate of 84.9% (95% CI, 76-91) among high-risk patients.
The therapy appeared equally effective across age groups and International Prognostic Index risk groups, and regardless of HIV status. Those with disease in the central nervous system had the highest risk for early toxicity-related death or treatment failure.
Five patients died of treatment-related causes during the study. Febrile neutropenia occurred in 16% of cycles, and five patients experienced tumor lysis syndrome.
“We demonstrated that risk-adapted DA-EPOCH-R is effective in adults with Burkitt lymphoma, irrespective of HIV status, with tolerable toxicity across all age groups,” Roschewski and colleagues wrote. “These results support our treatment strategies to ameliorate toxicity while maintaining efcacy. Indeed, they suggest highly dose-intensive chemotherapy is unnecessary for cure, and carefully dened low-risk patients may be treated with limited chemotherapy.”
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