1
|
Zhao J, Min H, Huang Y, Chen Y, Wang M, Xiao L, Wei G, Wu Y, Liu Y, Zhang W. Clinical characteristics and outcomes of newly diagnosed patients with human immunodeficiency virus-associated Burkitt lymphoma: the Central and Western China AIDS lymphoma league 002 study (CALL-002 study). Infect Agent Cancer 2023; 18:79. [PMID: 38053186 DOI: 10.1186/s13027-023-00559-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 11/10/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Despite the introduction of combined antiretroviral therapy, the clinical outcomes of HIV-associated Burkitt lymphoma (BL) remain poor. METHODS To evaluate the clinical characteristics, prognostic factors, and outcomes of HIV-associated BL, we conducted a retrospective analysis of patients from multiple centers in China. RESULTS The study included 41 patients from 8 medical centers. Among the included population, male patients accounted for 87.8%, with 75.6% in advanced stages. Notably, 46.3% of cases involved bone marrow, while 19.5% involved the central nervous system (CNS). The most commonly used chemotherapy regimen was DA-EPOCH ± R, accounting for 53.6% of cases. The overall response rates for patients receiving DA-EPOCH ± R and R-Hyper-CVAD were 59% and 58.2%, respectively. Interestingly, patients receiving regimens containing rituximab had similar complete remission rates (25% vs. 23.5%) and overall survival time (45.69 ± 11.58 vs. 47.79 ± 11.72 months, P = 0.907) compared to those without rituximab, but differed in progression rates (33.3% vs. 47.1%). For the entire cohort, the 1-year progression-free survival (PFS) and overall survival (OS) rates were 52% and 67%, respectively. CNS involvement was independent risk factors for survival, with 1-year PFS and OS rates of 0% and 38% for patients with CNS involvement, and PFS and OS rates of 66% and 75% for patients without CNS involvement. CONCLUSIONS HIV-associated BL patients in China have poor prognosis and show limited response to current treatment regimens. The absence of CNS involvement significantly improves clinical outcomes. The use of rituximab is not significantly associated with improved outcomes but can reduce disease progression.
Collapse
Affiliation(s)
- Jinrong Zhao
- Department of Hematology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, 1 Shuaifuyuan Wangfujing Street, Beijing, 100730, China
| | - Haiyan Min
- Yunnan Provincial Hospital of Infectious Diseases, Kunming, 650301, China
| | - Yunhong Huang
- Affiliated hospital of guizhou medical university, Guiyang, 550004, China
| | - Yaokai Chen
- Chonqging Public Health Medical Center, Chongqing, 400036, China
| | - Min Wang
- The First Hospital of Changsha, Changsha, 410011, China
| | - Lirong Xiao
- Henan Infectious Disease Hospital, The Sixth People's Hospital of Zhengzhou, Zhengzhou, 450015, China
| | - Guo Wei
- Public health clinical center of Chengdu, Chengdu, 610066, China
| | - Yan Wu
- Henan Infectious Disease Hospital, The Sixth People's Hospital of Zhengzhou, Zhengzhou, 450015, China.
| | - Yao Liu
- Department of Hematology Oncology, Chongqing University Cancer Hospital, Chongqing, 400030, China.
| | - Wei Zhang
- Department of Hematology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, 1 Shuaifuyuan Wangfujing Street, Beijing, 100730, China.
| |
Collapse
|
2
|
Affiliation(s)
- Mark Roschewski
- From the Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Louis M Staudt
- From the Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Wyndham H Wilson
- From the Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| |
Collapse
|
3
|
Lv K, Yin T, Yu M, Chen Z, Zhou Y, Li F. Treatment Advances in EBV Related Lymphoproliferative Diseases. Front Oncol 2022; 12:838817. [PMID: 35515118 PMCID: PMC9063483 DOI: 10.3389/fonc.2022.838817] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 03/11/2022] [Indexed: 12/24/2022] Open
Abstract
Epstein Barr virus (EBV) can affect 90% of the human population. It can invade B lymphocytes, T lymphocytes and natural killer cells of the host and remain in the host for life. The long latency and reactivation of EBV can cause malignant transformation, leading to various lymphoproliferative diseases (LPDs), including EBV-related B-cell lymphoproliferative diseases (EBV-B-LPDs) (for example, Burkitt lymphoma (BL), classic Hodgkin's lymphoma (cHL), and posttransplantation and HIV-related lymphoproliferative diseases) and EBV-related T-cell lymphoproliferative diseases (EBV-T/NK-LPDs) (for example, extranodal nasal type natural killer/T-cell lymphoma (ENKTCL), aggressive NK cell leukaemia (ANKL), and peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS). EBV-LPDs are heterogeneous with different clinical features and prognoses. The treatment of EBV-LPDs is usually similar to that of EBV-negative lymphoma with the same histology and can include chemotherapy, radiotherapy, and hematopoietic stem cell transplant (HSCT). However, problems such as serious toxicity and drug resistance worsen the survival prognosis of patients. EBV expresses a variety of viral and lytic proteins that regulate cell cycle and death processes and promote the survival of tumour cells. Based on these characteristics, a series of treatment strategies for EBV in related malignant tumours have been developed, such as monoclonal antibodies, immune checkpoint inhibitors, cytotoxic T lymphocytes (CTLs) and epigenetic therapy. These new individualized therapies can produce highly specific killing effects on tumour cells, and nontumour cells can be protected from toxicity. This paper will focus on the latest progress in the treatment of EBV-LPDs based on pathological mechanisms.
Collapse
Affiliation(s)
- Kebing Lv
- Center of Hematology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Ting Yin
- Center of Hematology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Min Yu
- Center of Hematology, The First Affiliated Hospital of Nanchang University, Nanchang, China.,Institute of Hematology, Academy of Clinical Medicine of Jiangxi Province, Nanchang, China.,Clinical Research Center for Hematologic Disease of Jiangxi Province, Nanchang, China.,Institute of Lymphoma and Myeloma, Nanchang University, Nanchang, China
| | - Zhiwei Chen
- Center of Hematology, The First Affiliated Hospital of Nanchang University, Nanchang, China.,Institute of Hematology, Academy of Clinical Medicine of Jiangxi Province, Nanchang, China.,Clinical Research Center for Hematologic Disease of Jiangxi Province, Nanchang, China.,Institute of Lymphoma and Myeloma, Nanchang University, Nanchang, China
| | - Yulan Zhou
- Center of Hematology, The First Affiliated Hospital of Nanchang University, Nanchang, China.,Institute of Hematology, Academy of Clinical Medicine of Jiangxi Province, Nanchang, China.,Clinical Research Center for Hematologic Disease of Jiangxi Province, Nanchang, China.,Institute of Lymphoma and Myeloma, Nanchang University, Nanchang, China
| | - Fei Li
- Center of Hematology, The First Affiliated Hospital of Nanchang University, Nanchang, China.,Institute of Hematology, Academy of Clinical Medicine of Jiangxi Province, Nanchang, China.,Clinical Research Center for Hematologic Disease of Jiangxi Province, Nanchang, China.,Institute of Lymphoma and Myeloma, Nanchang University, Nanchang, China
| |
Collapse
|
4
|
Ma'koseh M, Amarin R, Tamimi F, Sharaf B, Abufara A, Shahin O, Manassra MKM, Halahleh K. Treatment of adult Burkitt lymphoma with the CALGB 1002 protocol: a single center experience in Jordan. Blood Res 2021; 56:279-284. [PMID: 34880141 PMCID: PMC8721458 DOI: 10.5045/br.2021.2021116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/28/2021] [Accepted: 10/13/2021] [Indexed: 12/24/2022] Open
Abstract
Background The treatment of adult Burkitt lymphoma with pediatric-based chemotherapy protocols usually results in high cure rates, although with significant toxicity. We report our experience with the Cancer and Leukemia Group B1002 (CALGB 1002) protocol. Methods The files of adult patients diagnosed with Burkitt lymphoma and treated with the CALGB 1002 protocol at King Hussein Cancer Center between 2008 and 2017 were reviewed. Baseline demographics, clinical laboratory features, treatment details, and responses were collected. The correlations between clinical and laboratory variables with event-free survival (EFS) and overall survival (OS) were determined by univariate and multivariate analyses using backward stepwise Cox regression models. EFS and OS were plotted using Kaplan‒Meier curves. Results This study included 19 patients with a median age of 33 years (range, 19‒65). Eleven (58%) and two (10.5%) patients had advanced-stage and central nervous system disease, respectively. Among 106 administered cycles, the median interval between cycles was 23 days (range, 19‒84 days). Sixteen patients (84%) achieved a complete response. After a median follow-up of 40.8 months, the 3-year EFS and OS rates were 78.95%. Patients with a low-risk International Prognostic Index (IPI) had better survival than those with intermediate-or high-risk IPI. Grade III‒IV hematological toxicities occurred in 88% of patients, while 73% had grade III‒IV mucositis. Conclusion In adult Burkitt lymphoma, the CALGB 1002 protocol provides high cure rates and can be administered promptly, but is associated with significant toxicity. Risk-adapted approaches and other, less toxic, chemotherapeutic regimens should be considered.
Collapse
Affiliation(s)
- Mohammad Ma'koseh
- Department of Medical Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Rula Amarin
- Department of Medical Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Faris Tamimi
- Department of Medical Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Baha' Sharaf
- Department of Medical Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Alaa Abufara
- Department of Medical Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Omar Shahin
- Department of Medical Oncology, King Hussein Cancer Center, Amman, Jordan
| | | | - Khalid Halahleh
- Department of Medical Oncology, King Hussein Cancer Center, Amman, Jordan
| |
Collapse
|
5
|
Pereira RF, Mauro GP, Medici CTM, Casimiro LC, Weltman E. Radiotherapy in Adult Burkitt Lymphoma: A Retrospective Analysis in a Large University Center. Indian J Hematol Blood Transfus 2021; 38:508-515. [DOI: 10.1007/s12288-021-01495-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 09/30/2021] [Indexed: 10/20/2022] Open
|
6
|
The treatment of Burkitt lymphoma in adults. Blood 2021; 137:743-750. [PMID: 33171490 DOI: 10.1182/blood.2019004099] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 10/30/2020] [Indexed: 12/19/2022] Open
Abstract
Burkitt lymphoma (BL) is a highly aggressive, B-cell, non-Hodgkin lymphoma categorized into endemic, sporadic, and immunodeficiency-associated subtypes. BL has distinct pathologic and clinical features, characterized by rapidly progressive tumors with high rates of extranodal involvement. Next-generation-sequencing analyses have further characterized the genomic landscape of BL and our understanding of disease pathogenesis, although these findings have yet to influence treatment. Although most patients are cured with intensive combination chemotherapy, given the paucity of randomized trials, optimal therapy has not been defined. Furthermore, treatment of elderly patients, patients with central nervous system involvement, or those with relapsed disease remains an unmet need. In this review, we highlight the clinical, pathologic, and genomic features, as well as standard and emerging treatment options for adult patients with BL.
Collapse
|
7
|
Lap CJ, Nassereddine S, Dunleavy K. Novel Biological Insights and New Developments in Management of Burkitt Lymphoma and High-Grade B-Cell Lymphoma. Curr Treat Options Oncol 2021; 22:60. [PMID: 34097157 DOI: 10.1007/s11864-021-00857-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2021] [Indexed: 12/16/2022]
Abstract
OPINION STATEMENT Burkitt lymphoma (BL) is highly curable, and prompt institution of therapy is critical to achieving optimal outcomes. Although current "standard" approaches are very effective in disease eradication, treatment-related toxicity makes optimal delivery of curative therapy a challenge, especially in older and immunocompromised individuals. Reduced intensity approaches with fewer toxic complications have been the focus of some recent studies. A critical question is if they can replace "standard" approaches by maintaining high curability with improved tolerability. Additionally, new molecular insights in BL biology suggest that in the future, "targeted therapy" approaches may be feasible using small molecule inhibitors and novel strategies. Recently, a new category of aggressive lymphoma named "high-grade B-cell lymphoma (HGBL) with MYC and BCL2 and/or BCL6 translocations" has been recognized. This category overlaps clinically and biologically with BL and has an inferior prognosis compared to most B-cell lymphomas, and the optimal approach to its management remains, as yet, undefined. In this review, we discuss the current landscape of BL treatment including recent results with low-intensity regimens and also consider current approaches to HGBL. We also explore how recently elucidated novel biological insights in BL biology may shape future therapeutic directions including the use of novel cellular therapy approaches.
Collapse
Affiliation(s)
- Coen J Lap
- Department of Hematology and Oncology, Medical Faculty Associates, George Washington University, Washington, DC, USA
- The George Washington University School of Medicine, Washington, DC, USA
| | - Samah Nassereddine
- Department of Hematology and Oncology, Medical Faculty Associates, George Washington University, Washington, DC, USA
- The George Washington University School of Medicine, Washington, DC, USA
| | - Kieron Dunleavy
- Division of Hematology-Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC, USA.
| |
Collapse
|
8
|
Di Francia R, Crisci S, De Monaco A, Cafiero C, Re A, Iaccarino G, De Filippi R, Frigeri F, Corazzelli G, Micera A, Pinto A. Response and Toxicity to Cytarabine Therapy in Leukemia and Lymphoma: From Dose Puzzle to Pharmacogenomic Biomarkers. Cancers (Basel) 2021; 13:cancers13050966. [PMID: 33669053 PMCID: PMC7956511 DOI: 10.3390/cancers13050966] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 02/18/2021] [Accepted: 02/19/2021] [Indexed: 01/04/2023] Open
Abstract
Simple Summary In this review, the authors propose a crosswise examination of cytarabine-related issues ranging from the spectrum of clinical activity and severe toxicities, through updated cellular pharmacology and drug formulations, to the genetic variants associated with drug-induced phenotypes. Cytarabine (cytosine arabinoside; Ara-C) in multiagent chemotherapy regimens is often used for leukemia or lymphoma treatments, as well as neoplastic meningitis. Chemotherapy regimens can induce a suboptimal clinical outcome in a fraction of patients. The individual variability in clinical response to Leukemia & Lymphoma treatments among patients appears to be associated with intracellular accumulation of Ara-CTP due to genetic variants related to metabolic enzymes. The review provides exhaustive information on the effects of Ara-C-based therapies, the adverse drug reaction will also be provided including bone pain, ocular toxicity (corneal pain, keratoconjunctivitis, and blurred vision), maculopapular rash, and occasional chest pain. Evidence for predicting the response to cytarabine-based treatments will be highlighted, pointing at their significant impact on the routine management of blood cancers. Abstract Cytarabine is a pyrimidine nucleoside analog, commonly used in multiagent chemotherapy regimens for the treatment of leukemia and lymphoma, as well as for neoplastic meningitis. Ara-C-based chemotherapy regimens can induce a suboptimal clinical outcome in a fraction of patients. Several studies suggest that the individual variability in clinical response to Leukemia & Lymphoma treatments among patients, underlying either Ara-C mechanism resistance or toxicity, appears to be associated with the intracellular accumulation and retention of Ara-CTP due to genetic variants related to metabolic enzymes. Herein, we reported (a) the latest Pharmacogenomics biomarkers associated with the response to cytarabine and (b) the new drug formulations with optimized pharmacokinetics. The purpose of this review is to provide readers with detailed and comprehensive information on the effects of Ara-C-based therapies, from biological to clinical practice, maintaining high the interest of both researcher and clinical hematologist. This review could help clinicians in predicting the response to cytarabine-based treatments.
Collapse
Affiliation(s)
- Raffaele Di Francia
- Italian Association of Pharmacogenomics and Molecular Diagnostics, 60126 Ancona, Italy;
| | - Stefania Crisci
- Hematology-Oncology and Stem Cell transplantation Unit, National Cancer Institute, Fondazione “G. Pascale” IRCCS, 80131 Naples, Italy; (S.C.); (G.I.); (R.D.F.); (G.C.); (A.P.)
| | - Angela De Monaco
- Clinical Patology, ASL Napoli 2 Nord, “S.M. delle Grazie Hospital”, 80078 Pozzuoli, Italy;
| | - Concetta Cafiero
- Medical Oncology, S.G. Moscati, Statte, 74010 Taranto, Italy
- Correspondence: or (C.C.); (A.M.); Tel.:+39-34-0101-2002 (C.C.); +39-06-4554-1191 (A.M.)
| | - Agnese Re
- Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Giancarla Iaccarino
- Hematology-Oncology and Stem Cell transplantation Unit, National Cancer Institute, Fondazione “G. Pascale” IRCCS, 80131 Naples, Italy; (S.C.); (G.I.); (R.D.F.); (G.C.); (A.P.)
| | - Rosaria De Filippi
- Hematology-Oncology and Stem Cell transplantation Unit, National Cancer Institute, Fondazione “G. Pascale” IRCCS, 80131 Naples, Italy; (S.C.); (G.I.); (R.D.F.); (G.C.); (A.P.)
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy
| | | | - Gaetano Corazzelli
- Hematology-Oncology and Stem Cell transplantation Unit, National Cancer Institute, Fondazione “G. Pascale” IRCCS, 80131 Naples, Italy; (S.C.); (G.I.); (R.D.F.); (G.C.); (A.P.)
| | - Alessandra Micera
- Research and Development Laboratory for Biochemical, Molecular and Cellular Applications in Ophthalmological Sciences, IRCCS—Fondazione Bietti, 00184 Rome, Italy
- Correspondence: or (C.C.); (A.M.); Tel.:+39-34-0101-2002 (C.C.); +39-06-4554-1191 (A.M.)
| | - Antonio Pinto
- Hematology-Oncology and Stem Cell transplantation Unit, National Cancer Institute, Fondazione “G. Pascale” IRCCS, 80131 Naples, Italy; (S.C.); (G.I.); (R.D.F.); (G.C.); (A.P.)
| |
Collapse
|
9
|
Kim HD, Cho H, Kim S, Lee K, Kang EH, Park JS, Park CS, Huh J, Ryu JS, Lee SW, Yoon DH, Kim SJ, Ko YH, Kim WS, Suh C. Prognostic Stratification of Patients with Burkitt Lymphoma Using Serum β2-microglobulin Levels. Cancer Res Treat 2020; 53:847-856. [PMID: 33332932 PMCID: PMC8291169 DOI: 10.4143/crt.2020.1060] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 12/16/2020] [Indexed: 12/23/2022] Open
Abstract
Purpose We aimed to investigate the prognostic value of serum β2-microglobulin for patients with Burkitt lymphoma (BL) and to propose a risk-stratifying classification system. Materials and Methods A prospective registry-based cohort study of BL patients treated with dose-intensive or effective dose-adjusted chemotherapies (n=81) was conducted. Survival outcomes were compared based on previously reported risk groups and/or serum β2-microglobulin levels. A risk-stratifying classification system incorporating serum β2-microglobulin levels was proposed and validated in an independent validation cohort (n=60). Results The median age was 47 years, and 57 patients (70.4%) were male. Patients with high serum β2-microglobulin levels (> 2 mg/L) had significantly worse progression-free survival (PFS) and overall survival (OS) (p < 0.01 for both). Serum β2-microglobulin levels further stratified patients in the low-risk and high-risk groups in terms of PFS (p=0.010 and p=0.044, respectively) and OS (p=0.014 and p=0.026, respectively). Multivariate analyses revealed that a high serum β2-microglobulin level (> 2 mg/L) was independently associated with a shorter PFS (hazards ratio [HR], 3.56; p=0.047) and OS (HR, 4.66; p=0.043). The new classification system incorporating the serum β2-microglobulin level allowed the stratification of patients into three distinct risk subgroups with 5-year OS rates of 100%, 89.5%, and 62.5%. In an independent cohort of BL, the system was validated by stratifying patients with different survival outcomes. Conclusion Serum β2-microglobulin level is an independent prognostic factor for BL patients. The proposed β2-microglobulin–based classification system could stratify patients with distinct survival outcomes, which may help define appropriate treatment approaches for individual patients.
Collapse
Affiliation(s)
- Hyung-Don Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyungwoo Cho
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Shin Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyoungmin Lee
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Hee Kang
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung Sun Park
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chan-Sik Park
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jooryung Huh
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Sook Ryu
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang-Wook Lee
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dok-Hyun Yoon
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seok Jin Kim
- Division of Hematology Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Hyeh Ko
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Seog Kim
- Division of Hematology Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Cheolwon Suh
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
10
|
Roschewski M, Dunleavy K, Abramson JS, Powell BL, Link BK, Patel P, Bierman PJ, Jagadeesh D, Mitsuyasu RT, Peace D, Watson PR, Hanna WT, Melani C, Lucas AN, Steinberg SM, Pittaluga S, Jaffe ES, Friedberg JW, Kahl BS, Little RF, Bartlett NL, Fanale MA, Noy A, Wilson WH. Multicenter Study of Risk-Adapted Therapy With Dose-Adjusted EPOCH-R in Adults With Untreated Burkitt Lymphoma. J Clin Oncol 2020; 38:2519-2529. [PMID: 32453640 DOI: 10.1200/jco.20.00303] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Burkitt lymphoma is an aggressive B-cell lymphoma curable with dose-intensive chemotherapy derived from pediatric leukemia regimens. Treatment is acutely toxic with late sequelae. We hypothesized that dose-adjusted etoposide, doxorubicin, cyclophosphamide, vincristine, prednisone, and rituximab (DA-EPOCH-R) may obviate the need for highly dose-intensive chemotherapy in adults with Burkitt lymphoma. METHODS We conducted a multicenter risk-adapted study of DA-EPOCH-R in untreated adult Burkitt lymphoma. Low-risk patients received three cycles without CNS prophylaxis, and high-risk patients received six cycles with intrathecal CNS prophylaxis or extended intrathecal treatment if leptomeninges were involved. The primary endpoint was event-free survival (EFS), and secondary endpoints were toxicity and predictors of EFS and overall survival (OS). RESULTS Between 2010 and 2017, 113 patients were enrolled across 22 centers, and 98 (87%) were high risk. The median age was 49 (range, 18-86) years, and 62% were ≥ 40 years. Bone marrow and/or CSF was involved in 29 (26%) of patients, and 28 (25%) were HIV positive. At a median follow-up of 58.7 months, EFS and OS were 84.5% and 87.0%, respectively, and EFS was 100% and 82.1% in low- and high-risk patients. Therapy was equally effective across age groups, HIV status, and International Prognostic Index risk groups. Involvement of the CSF identified the group at greatest risk for early toxicity-related death or treatment failure. Five treatment-related deaths (4%) occurred during therapy. Febrile neutropenia occurred in 16% of cycles, and tumor lysis syndrome was rare. CONCLUSION Risk-adapted DA-EPOCH-R therapy is effective in adult Burkitt lymphoma regardless of age or HIV status and was well tolerated. Improved therapeutic strategies for adults with CSF involvement are needed (funded by the National Cancer Institute; ClinicalTrials.gov identifier: NCT01092182).
Collapse
Affiliation(s)
- Mark Roschewski
- Lymphoid Malignancies Branch, National Cancer Institute, Bethesda, MD
| | | | | | - Bayard L Powell
- Comprehensive Cancer Center of Wake Forest Baptist Health, Winston-Salem, NC
| | - Brian K Link
- University of Iowa Hospital and Clinics, Iowa City, IA
| | | | | | | | - Ronald T Mitsuyasu
- University of California Los Angeles Clinical AIDS Research and Education Center, Los Angeles, CA
| | | | | | - Wahid T Hanna
- University of Tennessee Medical Center, Knoxville, TN
| | | | - Andrea N Lucas
- Lymphoid Malignancies Branch, National Cancer Institute, Bethesda, MD
| | - Seth M Steinberg
- Biostatistics and Data Management Section, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - Stefania Pittaluga
- Hematopathology Section, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - Elaine S Jaffe
- Hematopathology Section, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | | | - Brad S Kahl
- Washington University School of Medicine, St. Louis, MO
| | - Richard F Little
- Division of Cancer Therapy and Diagnosis, National Cancer Institute, Bethesda, MD
| | | | - Michelle A Fanale
- MD Anderson Cancer Center, Houston, TX, and Seattle Genetics, Seattle, WA
| | - Ariela Noy
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Wyndham H Wilson
- Lymphoid Malignancies Branch, National Cancer Institute, Bethesda, MD
| |
Collapse
|
11
|
Phillips EH, Burton C, Kirkwood AA, Barrans S, Lawrie A, Rule S, Patmore R, Pettengell R, Ardeshna KM, Montoto S, Paneesha S, Clifton‐Hadley L, Linch DC, McMillan AK. Favourable outcomes for high‐risk Burkitt lymphoma patients (IPI 3‐5) treated with rituximab plus CODOX‐M/IVAC: Results of a phase 2 UK NCRI trial. ACTA ACUST UNITED AC 2020; 1:133-141. [PMID: 35847742 PMCID: PMC9176097 DOI: 10.1002/jha2.3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 03/12/2020] [Indexed: 01/17/2023]
Abstract
Introduction Outcomes after frontline treatment of Burkitt lymphoma (BL) have improved with the introduction of dose‐intense chemotherapy regimens, such as CODOX‐M/IVAC. While rituximab has increased survival rates for most forms of high‐grade B‐cell lymphoma, there has previously been hesitancy about incorporating it into BL treatment, partly due to concerns about increased toxicity. Prospective data using the standard dose CODOX‐M/IVAC regimen in combination with rituximab are lacking. We conducted a single‐arm phase 2 trial to assess the efficacy and toxicity of R‐CODOX‐M/R‐IVAC. Methods Eligible patients were aged 18–65 years, with newly diagnosed BL with MYC rearrangement as the sole cytogenetic abnormality, and high‐risk disease, defined by an International Prognostic Index (IPI) score of 3‐5. Patients received two cycles of R‐CODOX‐M chemotherapy alternating with two cycles of R‐IVAC, followed by two further cycles of rituximab alone. The primary endpoint was 2‐year progression‐free survival. Results Thirty‐eight patients were registered but after central pathology review, 27 patients had confirmed BL and commenced study treatment. Median age was 35 years, 14.8% patients had central nervous system involvement and 18.5% were HIV positive. Twenty‐two (81.4%) patients completed four cycles of chemotherapy. There were two treatment‐related deaths (7.4%). Two‐year progression‐free and overall survival rates were 77.2% (90% confidence interval [CI]: 56.0‐89.0) and 80.7% (90% CI: 59.6‐91.5), respectively. Conclusions This prospective trial demonstrates excellent survival rates with R‐CODOX‐M/R‐IVAC in a high‐risk BL cohort. It provides reassuring evidence regarding the feasibility of this regimen and also provides a benchmark for future studies.
Collapse
Affiliation(s)
- Elizabeth H. Phillips
- Division of Cancer Sciencesthe University of Manchester Manchester UK
- Cancer Research UK and UCL Cancer Trials Centre, UCL Cancer InstituteUniversity College London London UK
| | | | - Amy A. Kirkwood
- Cancer Research UK and UCL Cancer Trials Centre, UCL Cancer InstituteUniversity College London London UK
| | | | - Anthony Lawrie
- Cancer Research UK and UCL Cancer Trials Centre, UCL Cancer InstituteUniversity College London London UK
| | - Simon Rule
- Plymouth University Medical School Plymouth UK
| | | | - Ruth Pettengell
- Clinical Sciences Department, St George's University of London London UK
| | | | - Silvia Montoto
- Haemato‐oncology DepartmentBarts Health NHS Trust London UK
| | | | - Laura Clifton‐Hadley
- Cancer Research UK and UCL Cancer Trials Centre, UCL Cancer InstituteUniversity College London London UK
| | | | - Andrew K. McMillan
- Haematology DepartmentNottingham University Hospitals NHS Trust Nottingham UK
| |
Collapse
|
12
|
Abstract
B cell development and activation are accompanied by dynamic genetic alterations including V(D)J rearrangements and immunoglobulin-gene somatic hypermutation and class-switch recombination. Abnormalities in these genetic events can cause chromosomal translocations and genomic mutations, leading to altered expression and function of genes involved in B cell survival or proliferation and consequently B lymphomagenesis. In fact, B cell lymphoma accounts for 95% of the lymphomas. In this chapter, we summarize the morphology, immunophenotypes, clinical features, genetic defects that cause the malignancies, treatments, and prognosis of the most prevalent types of B cell lymphomas, including typical precursor B cell malignance (B-ALL/LBL) and mature B cell lymphoma (Hodgkin lymphoma and B cell non-Hodgkin lymphoma).
Collapse
Affiliation(s)
- Xin Meng
- Department of Immunology, School of Basic Medical Sciences, Fudan University, Shanghai, China
| | - Qing Min
- Department of Immunology, School of Basic Medical Sciences, Fudan University, Shanghai, China
| | - Ji-Yang Wang
- Department of Immunology, School of Basic Medical Sciences, Fudan University, Shanghai, China.
| |
Collapse
|
13
|
Lu J, Tan H, Li B, Chen S, Xu L, Zou Y. Status and prognostic nomogram of patients with Burkitt lymphoma. Oncol Lett 2019; 19:972-984. [PMID: 31897210 PMCID: PMC6924199 DOI: 10.3892/ol.2019.11155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 10/23/2019] [Indexed: 12/26/2022] Open
Abstract
The purpose of the present study was to evaluate the newest status of patients diagnosed Burkitt lymphoma (BL), an aggressive lymphoma subset with a high cure rate. Furthermore, the study aimed to create prognostic nomograms to consider various prognostic factors and estimate patient survival, paving the way for clinical decision-making. A total of 4,600 patients diagnosed with BL between 1983 and 2015 were investigated, via data collected from the SEER database. The overall status of the patients was analyzed through several aspects, including incidence and survival analysis of the previous three decades using the log-rank test and the Kaplan-Meier method. In order to construct and validate the nomograms, the patient diagnosed during 2005-2015 were randomly assigned to the training cohort and validation cohort. Univariate and multivariate analyses were applied to identify independent factors that were further included in the nomograms, predicting 3- and 5-year overall survival (OS) and cancer-specific survival (CSS). The data of the training cohort were used for internal validation and validation cohort used to external validation. C-index and calibration plots were used to validate the nomograms, comparing predicted values with actual outcomes. The incidence of BL was gradually increased from 1984 and reached its peak in 2009, at a rate of 0.491 per 100,000 [95% confidence interval (CI), 0.412-0.581]. From 2009, the incidence slowly declined year by year and dropped to 0.280 per 100,000 (95% CI, 0.224-0.346). The OS and CSS rates of patients diagnosed between 2005 and 2015 were increased, in contrast with those of patients diagnosed from 1983-1993 and 1994-2004. A total of five variables, including age, race, chemotherapy, primary site and stage, proved to be the prognostic factors of BL and were used to construct the nomograms predicting 3- and 5-year OS and CSS. The internal and external calibration plots for the probability of 3- and 5-year OS and CSS were consistent between nomogram prediction and observed outcomes. The slow decline in incidence and the significantly improved cure rate make BL a disease that is no longer an urgent problem. Effective nomograms were developed to predict the OS and CSS of patients with BL.
Collapse
Affiliation(s)
- Jielun Lu
- Department of Pediatrics, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510000, P.R. China
| | - Huo Tan
- Department of Hematology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510000, P.R. China
| | - Bo Li
- Department of Pediatrics, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510000, P.R. China
| | - Shuyi Chen
- Department of Hematology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510000, P.R. China
| | - Lihua Xu
- Department of Hematology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510000, P.R. China
| | - Yawei Zou
- Department of Pediatrics, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510000, P.R. China
| |
Collapse
|
14
|
Santambrogio E, Nicolosi M, Vassallo F, Castellino A, Novo M, Chiappella A, Vitolo U. Aggressive Non-Hodgkin lymphomas: risk factors and treatment of central nervous system recurrence. Expert Rev Hematol 2019; 12:787-796. [DOI: 10.1080/17474086.2019.1643232] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Elisa Santambrogio
- Hematology, Città della Salute e della Scienza Hospital and University, Torino, Italy
| | - Maura Nicolosi
- Hematology, Città della Salute e della Scienza Hospital and University, Torino, Italy
| | - Francesco Vassallo
- Hematology, Città della Salute e della Scienza Hospital and University, Torino, Italy
| | - Alessia Castellino
- Hematology, Città della Salute e della Scienza Hospital and University, Torino, Italy
| | - Mattia Novo
- Hematology, Città della Salute e della Scienza Hospital and University, Torino, Italy
| | - Annalisa Chiappella
- Hematology, Città della Salute e della Scienza Hospital and University, Torino, Italy
| | - Umberto Vitolo
- Hematology, Città della Salute e della Scienza Hospital and University, Torino, Italy
| |
Collapse
|
15
|
Crombie JL, LaCasce AS. Epstein Barr Virus Associated B-Cell Lymphomas and Iatrogenic Lymphoproliferative Disorders. Front Oncol 2019; 9:109. [PMID: 30899698 PMCID: PMC6416204 DOI: 10.3389/fonc.2019.00109] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 02/05/2019] [Indexed: 12/17/2022] Open
Abstract
Epstein-Barr virus (EBV) is a ubiquitous herpesvirus, affecting up to 90% of the population. EBV was first identified as an oncogenic virus in a Burkitt lymphoma cell line, though subsequently has been found to drive a variety of malignancies, including diffuse large B-cell lymphoma (DLBCL) and other lymphoma subtypes. EBV has a tropism for B-lymphocytes and has the unique ability to exist in a latent state, evading the host immune response. In cases of impaired cell mediated immunity, as in patients with advanced age or iatrogenic immune suppression, the virus is able to proliferate in an unregulated fashion, expressing viral antigens that predispose to transformation. EBV-positive DLBCL not otherwise specified, which has been included as a revised provisional entity in the 2016 WHO classification of lymphoid malignancies, is thought to commonly occur in older patients with immunosenescence. Similarly, it is well-established that iatrogenic immune suppression, occurring in both transplant and non-transplant settings, can predispose to EBV-driven lymphoproliferative disorders. EBV-positive lymphoproliferative disorders are heterogeneous, with variable clinical features and prognoses depending on the context in which they arise. While DLBCL is the most common subtype, other histologic variants, including Burkitt lymphoma, NK/T-cell lymphoma, and Hodgkin lymphoma can occur. Research aimed at understanding the underlying biology and disease prevention strategies in EBV-associated lymphoproliferative diseases are ongoing. Additionally, personalized treatment approaches, such as immunotherapy and adoptive T-cell therapies, have yielded encouraging results, though randomized trials are needed to further define optimal management.
Collapse
Affiliation(s)
- Jennifer L Crombie
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Ann S LaCasce
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| |
Collapse
|
16
|
Silva Junior WFD, Rosa LID, Belesso M, Lage LAPC, Rocha V, Pereira J. Treatment outcomes of adult Burkitt lymphoma: results with a modified LMB protocol in Brazil and feasibility of outpatient administration. J Chemother 2019; 30:375-379. [DOI: 10.1080/1120009x.2018.1535771] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - Lidiane Inês da Rosa
- Department of Hematology, Institute of Cancer of São Paulo (ICESP), University of São Paulo, São Paulo, Brazil
| | - Marcelo Belesso
- Department of Hematology, Institute of Cancer of São Paulo (ICESP), University of São Paulo, São Paulo, Brazil
| | - Luís Alberto P. C. Lage
- Department of Hematology, Institute of Cancer of São Paulo (ICESP), University of São Paulo, São Paulo, Brazil
| | - Vanderson Rocha
- Department of Hematology, Institute of Cancer of São Paulo (ICESP), University of São Paulo, São Paulo, Brazil
| | - Juliana Pereira
- Department of Hematology, Institute of Cancer of São Paulo (ICESP), University of São Paulo, São Paulo, Brazil
| |
Collapse
|
17
|
Radiation Therapy in Burkitt Lymphoma. Radiat Oncol 2018. [DOI: 10.1007/978-3-319-52619-5_25-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
|
18
|
Dozzo M, Carobolante F, Donisi PM, Scattolin A, Maino E, Sancetta R, Viero P, Bassan R. Burkitt lymphoma in adolescents and young adults: management challenges. Adolesc Health Med Ther 2017; 8:11-29. [PMID: 28096698 PMCID: PMC5207020 DOI: 10.2147/ahmt.s94170] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
About one-half of all Burkitt lymphoma (BL) patients are younger than 40 years, and one-third belong to the adolescent and young adult (AYA) subset, defined by an age between 15 and 25-40 years, based on selection criteria used in different reports. BL is an aggressive B-cell neoplasm displaying highly characteristic clinico-diagnostic features, the biologic hallmark of which is a translocation involving immunoglobulin and c-MYC genes. It presents as sporadic, endemic, or epidemic disease. Endemicity is pathogenetically linked to an imbalance of the immune system which occurs in African children infected by malaria parasites and Epstein-Barr virus, while the epidemic form strictly follows the pattern of infection by HIV. BL shows propensity to extranodal involvement of abdominal organs, bone marrow, and central nervous system, and can cause severe metabolic and renal impairment. Nevertheless, BL is highly responsive to specifically designed short-intensive, rotational multiagent chemotherapy programs, empowered by the anti-CD20 monoclonal antibody rituximab. When carefully applied with appropriate supportive measures, these modern programs achieve a cure rate of approximately 90% in the average AYA patient, irrespective of clinical stage, which is the best result achievable in any aggressive lymphoid malignancy to date. The challenges ahead concern the following: optimization of management in underdeveloped countries, with reduction of diagnostic and referral-for-care intervals, and the applicability of currently curative regimens; the development of lower intensity but equally effective treatments for frail or immunocompromised patients at risk of death by complications; the identification of very high-risk patients through positron-emission tomography and minimal residual disease assays; and the assessment in these and the few refractory/relapsed ones of new monoclonals (ofatumumab, blinatumomab, inotuzumab ozogamicin) and new molecules targeting c-MYC and key proliferative steps of B-cell malignancies.
Collapse
Affiliation(s)
- Massimo Dozzo
- Complex Operative Unit of Hematology, Ospedale dell’Angelo
| | | | - Pietro Maria Donisi
- Simple Departmental Operative Unit of Anatomic Pathology, Ospedale Ss. Giovanni e Paolo, Venice, Italy
| | | | - Elena Maino
- Complex Operative Unit of Hematology, Ospedale dell’Angelo
| | | | - Piera Viero
- Complex Operative Unit of Hematology, Ospedale dell’Angelo
| | - Renato Bassan
- Complex Operative Unit of Hematology, Ospedale dell’Angelo
- Correspondence: Renato Bassan, Complex Operative Unit of Hematology, Ospedale dell’Angelo, Via Paccagnella 11, 30174 Mestre-Venice, Italy, Tel +39 41 965 7362, Fax +39 41 965 7361, Email
| |
Collapse
|
19
|
Doval DC, Bhurani D, Nair R, Gujral S, Malhotra P, Ramanan G, Mohan R, Biswas G, Dattatreya S, Agarwal S, Pendharkar D, Julka PK, Advani SH, Dhaliwal RS, Tayal J, Sinha R, Kaur T, Rath GK. Indian Council of Medical Research Consensus Document for the Management of Non-Hodgkin's Lymphoma (High Grade). Indian J Med Paediatr Oncol 2017; 38:51-58. [PMID: 28469337 PMCID: PMC5398107 DOI: 10.4103/0971-5851.203500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This consensus document is based on the guidelines related to the management of Non Hodgkin's Lymphoma (High grade) in the Indian population as proposed by the core expert committee. Accurate diagnosis in hematolymphoid neoplasm requires a combination of detailed history,clinical examination, and various investigations including routine laboratory tests, good quality histology section (of tumor and also bone marrow aspirate/biopsy), immunostaining, cytogenetic and molecular studies and radiology investigations. The staging system used for adult high grade lymphomas is based on the Ann Arbor system and includes various parameters like clinical, haematology, biochemistry, serology and radiology. Response should be evaluated with radiological evaluation after 3-4 cycles and at the end of treatment based on criteria including and excluding PET. Treatment of high grade lymphomas is based on histologic subtype, extent of disease, and age of the patient. Autologous stem cell transplantation after high dose chemotherapy is effective in the treatment of relapsed NHL. Newer RT techniques like 3 dimensional conformal radiation therapy (3D-CRT) and intensity modulated radiation therapy (IMRT) can significantly reduce radiation doses to surrounding normal tissues in lymphoma patients. Patients should be followed up every 3 to 4 months for the first 2 years, followed by 6 monthly for the next 3 years and then annually.
Collapse
Affiliation(s)
- Dinesh Chandra Doval
- Department of Research, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Dinesh Bhurani
- Department of Research, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Reena Nair
- Department of Hemato oncology, Tata Memorial Centre, Kolkata, West Bengal, India
| | - Sumeet Gujral
- Department of Hemato Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Pankaj Malhotra
- Department of Clinical Haematology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ganpati Ramanan
- Department of Medical Oncology, Apollo MultiSpecialty Hospital, Chennai, Tamil Nadu, India
| | - Ravi Mohan
- Department of Internal Medicine and Medical Oncology, Guntur Medical College, Guntur, Andhra Pradesh, India
| | - Ghanshyam Biswas
- Department of Medical Oncology, Sparsh Hospitals and Critical Care, Bhubaneswar, Odisha, India
| | - Satya Dattatreya
- Department of Medical Oncology, Omega Hospital, Hyderabad, Telangana, India
| | - Shyam Agarwal
- Department of Medical Oncology, Sir Ganga Ram Hospital, New Delhi, India
| | - Dinesh Pendharkar
- Division of Non Communicable Disease, Indian Council of Medical Research, New Delhi, India
| | - Pramod Kumar Julka
- Department of Radiotherapy, Dr. BR Ambedkar Institute of Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Suresh H Advani
- Department of Medical Oncology, SL Raheja Hospital, Mumbai, Maharashtra, India
| | | | - Juhi Tayal
- Department of Research, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Rupal Sinha
- Department of Research, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Tanvir Kaur
- Division of Non Communicable Disease, Indian Council of Medical Research, New Delhi, India
| | - Goura K Rath
- Department of Radiotherapy, Dr. BR Ambedkar Institute of Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
20
|
|
21
|
Abstract
Abstract
Burkitt lymphoma (BL) is an aggressive B-cell non-Hodgkin lymphoma that is almost uniformly associated with translocations involving the gene for MYC on chromosome 8. The 3 subtypes of BL, endemic, sporadic, and immunodeficiency-associated, differ from epidemiologic and clinical perspectives but may be genetically similar. Prompt administration of multiagent immunochemotherapy regimens is associated with favorable outcomes for the majority of patients. Survival is inferior in older patients, likely reflecting increased therapy-related toxicity, possibly resulting in decreased treatment intensity. Central nervous system prophylaxis, tumor lysis prevention and treatment, and management of infectious complications from myelosuppressive regimens are critical. Prognosis of refractory or relapsed disease is poor and patients are best treated on clinical trials when available.
Collapse
|
22
|
Improved outcome of adult Burkitt lymphoma/leukemia with rituximab and chemotherapy: report of a large prospective multicenter trial. Blood 2014; 124:3870-9. [PMID: 25359988 DOI: 10.1182/blood-2014-03-563627] [Citation(s) in RCA: 187] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
This largest prospective multicenter trial for adult patients with Burkitt lymphoma/leukemia aimed to prove the efficacy and feasibility of short-intensive chemotherapy combined with the anti-CD20 antibody rituximab. From 2002 to 2011, 363 patients 16 to 85 years old were recruited in 98 centers. Treatment consisted of 6 5-day chemotherapy cycles with high-dose methotrexate, high-dose cytosine arabinoside, cyclophosphamide, etoposide, ifosphamide, corticosteroids, and triple intrathecal therapy. Patients >55 years old received a reduced regimen. Rituximab was given before each cycle and twice as maintenance, for a total of 8 doses. The rate of complete remission was 88% (319/363); overall survival (OS) at 5 years, 80%; and progression-free survival, 71%; with significant difference between adolescents, adults, and elderly patients (OS rate of 90%, 84%, and 62%, respectively). Full treatment could be applied in 86% of the patients. The most important prognostic factors were International Prognostic Index (IPI) score (0-2 vs 3-5; P = .0005), age-adjusted IPI score (0-1 vs 2-3; P = .0001), and gender (male vs female; P = .004). The high cure rate in this prospective trial with a substantial number of participating hospitals demonstrates the efficacy and feasibility of chemoimmunotherapy, even in elderly patients. This trial was registered at www.clinicaltrials.gov as #NCT00199082.
Collapse
|
23
|
Le Jeune C, Thomas X. Antibody-based therapies in B-cell lineage acute lymphoblastic leukaemia. Eur J Haematol 2014; 94:99-108. [DOI: 10.1111/ejh.12408] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2014] [Indexed: 12/12/2022]
Affiliation(s)
- Caroline Le Jeune
- Hematology Department; Hospices Civils de Lyon; Lyon-Sud Hospital; Pierre Bénite France
| | - Xavier Thomas
- Hematology Department; Hospices Civils de Lyon; Lyon-Sud Hospital; Pierre Bénite France
| |
Collapse
|
24
|
Wildes TM, Farrington L, Yeung C, Harrington AM, Foyil KV, Liu J, Kreisel F, Bartlett NL, Fenske TS. Rituximab is associated with improved survival in Burkitt lymphoma: a retrospective analysis from two US academic medical centers. Ther Adv Hematol 2014; 5:3-12. [PMID: 24490019 DOI: 10.1177/2040620713514682] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Burkitt lymphoma (BL) is a rare, highly aggressive B-cell malignancy treated most successfully with brief-duration, high-intensity chemotherapeutic regimens. The benefit of the addition of rituximab to these regimens remains uncertain. We sought to examine the effectiveness of chemotherapy with and without rituximab in patients with BL. METHODS This study is a retrospective cohort study of all adult patients with BL diagnosed and treated with modern, dose-intense chemotherapeutic regimens from 1998-2008 at two tertiary care institutions. All cases were confirmed by application of WHO 2008 criteria by hematopathologists. Medical records were reviewed for patient-, disease-, and treatment- related factors as well as treatment response and survival. Factors associated with survival were analyzed using Cox proportional hazards modeling. RESULTS A total of 35 patients were analyzed: 18 patients received rituximab with chemotherapy (R-chemo) and 17 received chemotherapy (chemo) alone. The median age was 42 (range 20-74 years); 57% were male; 71% had Ann Arbor Stage IV disease; 33% had central nervous system involvement; 78% had an Eastern Cooperative Oncology Group (ECOG) performance status of 0-1. R-chemo was associated with significantly longer overall survival (OS) than chemo alone (5-year OS 70% and 29%, respectively, p = 0.040). On multivariate regression analysis, poor performance status and central nervous system involvement were associated with poorer survival. CONCLUSIONS The addition of rituximab to chemotherapy was associated with improved OS in patients with Burkitt lymphoma. Poor performance status and central nervous system involvement were prognostically significant on multivariate analysis.
Collapse
Affiliation(s)
- Tanya M Wildes
- Division of Medical Oncology, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8056, St Louis, MO 63110, USA
| | - Laura Farrington
- Division of Hematology and Oncology, East Tennessee State University College of Medicine, Johnson City, TN, USA
| | - Cecilia Yeung
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | - Kelley V Foyil
- Division of Medical Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Jingxia Liu
- Division of Biostatistics, Washington University School of Medicine, St Louis, MO, USA
| | - Friederike Kreisel
- Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO, USA
| | - Nancy L Bartlett
- Division of Medical Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Timothy S Fenske
- Medical College of Wisconsin, Division of Hematology & Oncology, Milwaukee, WI, USA
| |
Collapse
|
25
|
Rizzieri DA, Johnson JL, Byrd JC, Lozanski G, Blum KA, Powell BL, Shea TC, Nattam S, Hoke E, Cheson BD, Larson RA. Improved efficacy using rituximab and brief duration, high intensity chemotherapy with filgrastim support for Burkitt or aggressive lymphomas: cancer and Leukemia Group B study 10 002. Br J Haematol 2014; 165:102-11. [PMID: 24428673 DOI: 10.1111/bjh.12736] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 11/08/2013] [Indexed: 01/30/2023]
Abstract
To improve long-term outcomes for Burkitt leukaemia/lymphoma (BL) or aggressive lymphomas in adults, we assessed the benefit of adding rituximab and filgrastim support to a dose-dense modified chemotherapy regimen from the Cancer and Leukemia Group B (CALGB) 9251 trial. One hundred and five patients (aged 19-79 years) were enrolled; 27% were >60 years old; 47% had high or high-intermediate risk by International Prognostic Index (IPI) criteria. Common severe toxicities included stomatitis/upper gastrointestinal toxicity (69%), renal insufficiency (10%), neurological events (25%) and pulmonary events (18%). Seven died from treatment-related causes (one central nervous system bleed, four infections, two respiratory failure); five were >60 years old. Results in this adult population are encouraging as complete response (CR) was observed in 83% and 4-year event-free (EFS) and overall survivals (OS) were 74% and 78%, respectively. Results compare favourably to our prior chemotherapy alone study (CALGB 9251) but despite this, high-risk patients still had worse outcomes. In conclusion, short duration, intensive chemo-immunotherapy is feasible and should be considered in adults with BL as it results in high remission rates and durable remissions.
Collapse
Affiliation(s)
- David A Rizzieri
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Abstract
Since its initial description in 1958, Burkitt lymphoma has become a prototype for our understanding of the pathogenesis and optimal treatment of aggressive lymphomas. The evolution of the treatment of this disease is explored and current therapeutic approaches evaluated. Special issues in the treatment of Burkitt lymphoma will also be discussed, including considerations in patients infected with HIV and current views on prophylactic measures and treatment of tumor lysis syndrome.
Collapse
Affiliation(s)
- John Gerecitano
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA. gerecitj@@mskcc.org
| | | |
Collapse
|
27
|
Abstract
Abstract
The application of high-throughput genomic approaches in lymphomas has generated a wealth of data regarding the molecular underpinnings of these cancers. In this review, key findings from recent studies are discussed, as well as the genetic heterogeneity that underlies common lymphomas including diffuse large B-cell lymphoma, Burkitt lymphoma, and chronic lymphocytic leukemia, and the implications for identifying new therapeutic opportunities and personalized medicine.
Collapse
|
28
|
Ribera JM, García O, Grande C, Esteve J, Oriol A, Bergua J, González-Campos J, Vall-llovera F, Tormo M, Hernández-Rivas JM, García D, Brunet S, Alonso N, Barba P, Miralles P, Llorente A, Montesinos P, Moreno MJ, Hernández-Rivas JÁ, Bernal T. Dose-intensive chemotherapy including rituximab in Burkitt's leukemia or lymphoma regardless of human immunodeficiency virus infection status. Cancer 2013; 119:1660-1668. [DOI: 10.1002/cncr.27918] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
|
29
|
Maramattom LV, Hari PN, Burns LJ, Carreras J, Arcese W, Cairo MS, Costa LJ, Fenske TS, Lill M, Freytes CO, Gale RP, Gross TG, Hale GA, Hamadani M, Holmberg LA, Hsu JW, Inwards DJ, Lazarus HM, Marks DI, Maloney DG, Maziarz RT, Montoto S, Rizzieri DA, Wirk B, Gajewski JL. Autologous and allogeneic transplantation for burkitt lymphoma outcomes and changes in utilization: a report from the center for international blood and marrow transplant research. Biol Blood Marrow Transplant 2013; 19:173-9. [PMID: 23200705 PMCID: PMC3553321 DOI: 10.1016/j.bbmt.2012.11.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Accepted: 11/01/2012] [Indexed: 11/30/2022]
Abstract
Trends in utilization and outcomes after autologous or allogeneic hematopoietic cell transplantation (HCT) for Burkitt lymphoma were analyzed in 241 recipients reported to the Center for International Blood and Marrow Transplant Research between 1985 and 2007. The autologous HCT cohort had a higher proportion of chemotherapy-sensitive disease, peripheral blood grafts, and HCT in first complete remission (CR1). The use of autologous HCT has declined over time, with only 19% done after 2001. Overall survival at 5 years for the autologous cohort was 83% for those in CR1 and 31% for those not in CR1. Corresponding progression-free survival (PFS) was 78% and 27%, respectively. After allogeneic HCT, overall survival at 5 years was 53% and 20% for the CR1 and non-CR1 cohorts, whereas PFS was 50% and 19%, respectively. The most common cause of death was progressive lymphoma. Allogeneic HCT performed in a higher-risk subset (per National Comprehensive Cancer Network guidelines) resulted in a 5-year PFS of 27%. Autologous HCT resulted in a 5-year PFS of 44% in those undergoing transplantation in the second CR.
Collapse
Affiliation(s)
| | - Parameswaran N. Hari
- Center for International Blood and Marrow Transplant Research, Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Linda J. Burns
- University of Minnesota Medical Center, Minneapolis, MN, USA
| | - Jeanette Carreras
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | | | | | - Timothy S. Fenske
- Center for International Blood and Marrow Transplant Research, Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Cesar O. Freytes
- South Veterans Health Care System and University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | | | | | | | - Mehdi Hamadani
- West Virginia University Hospitals, Inc., Morgantown, WV, USA
| | | | - Jack W. Hsu
- Shands HealthCare & University of Florida, Gainesville, FL, USA
| | | | | | | | | | | | - Silvia Montoto
- Barts Cancer Institute, Queen Mary University of London, London, United, Kingdom
| | | | - Baldeep Wirk
- Shands HealthCare & University of Florida, Gainesville, FL, USA
| | | |
Collapse
|
30
|
Kasamon YL, Brodsky RA, Borowitz MJ, Ambinder RF, Crilley PA, Cho SY, Tsai HL, Smith BD, Gladstone DE, Carraway HE, Huff CA, Matsui WH, Bolaños-Meade J, Jones RJ, Swinnen LJ. Brief intensive therapy for older adults with newly diagnosed Burkitt or atypical Burkitt lymphoma/leukemia. Leuk Lymphoma 2012; 54:483-90. [PMID: 22835045 DOI: 10.3109/10428194.2012.715346] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Older patients with Burkitt lymphoma/leukemia (BL) have inferior outcomes. Because cyclophosphamide is highly active in BL and can be dose-escalated without stem-cell rescue, we designed a short, cyclophosphamide-intensive regimen without anthracyclines for patients aged ≥ 30 with untreated, non-HIV-associated BL/atypical BL. Two cycles involving cyclophosphamide 1500 mg/m(2), vincristine, rituximab, prednisone, methotrexate 3 g/m(2), and intrathecal cytarabine were delivered 2 weeks apart, followed by intensification with high-dose cyclophosphamide (50 mg/kg/day for 4 days) and rituximab. Of 21 patients, median age 53 (range, 34-75), 71% had stage IV, 95% were high-risk and 29% had performance status 3-4. Response occurred in all evaluable patients post-cycle 2 and in 76% post-intensification. Five non-relapse deaths occurred (four before intensification). The estimated 1-year and 3-year event-free survival was 52%; 1-year and 3-year overall survival was 57%. Seventeen (81%) received intensification (median 30 days to intensification). Brief, anthracycline-sparing, intensive cyclophosphamide (BASIC) therapy yields durable remissions in poorer-risk BL/atypical BL.
Collapse
|
31
|
Abstract
Adult Burkitt lymphoma (BL) is an aggressive disease characterized by frequent extranodal presentation, bulky disease and a rapid clinical course. Although intensive chemotherapeutic regimes result in long-term disease-free survival in most patients, a significant proportion of patients will have high-risk disease that may be refractory or that will relapse. In these patients, the role of hematopoietic SCT is not well defined, especially in the era of modern chemoimmunotherapy. Upfront auto-SCT has been reported to be feasible in patients who have high-risk features at presentation, and in whom it is a clinical option. In patients with relapsed disease, auto-SCT can result in a PFS of 30-40%. Allo-SCT is an option in relapsing patients with a sibling or matched related donor who may not be eligible for, or may have previously received, an auto-SCT; the role of RIC and T-cell depletion is not well defined. Disease status at transplant is the most significant predictor of outcome in patients undergoing SCT. Here we review the available evidence pertaining to SCT in patients with BL, including in those who are HIV positive (HIV+) and those with B-cell lymphoma unclassified (BCLU). Prospective studies in the era of modern intensive chemoimmunotherapeutic regimes are required to delineate the precise role of transplantation for BL. Developments in molecular diagnostics, incorporation of FDG-PET and minimal residual disease monitoring along with new therapies may further assist in refining treatment algorithms.
Collapse
|
32
|
|
33
|
Todeschini G, Bonifacio M, Tecchio C, Balter R, Carli G, Stefani PM, Adami F, Zamò A, Dei Tos AP, Marino F, Gherlinzoni F, Marradi P, Semenzato G, Pizzolo G. Intensive short-term chemotherapy regimen induces high remission rate (over 90%) and event-free survival both in children and adult patients with advanced sporadic Burkitt lymphoma/leukemia. Am J Hematol 2012; 87:22-5. [PMID: 22086870 DOI: 10.1002/ajh.22189] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Accepted: 09/10/2011] [Indexed: 11/09/2022]
Abstract
The optimal treatment of advanced sporadic Burkitt lymphoma in adults is still a matter of debate. The salutary results of pediatric therapies did open the road for improving the adult outcome. Between May 1988 and March 2009, 71 consecutive patients-46 adults, 25 children-affected by Burkitt lymphoma/leukemia were treated with the same intensive pediatric protocol alternating vincristine, adriamycine and fractionated ciclophosphamide (phase A) with high dose methotrexate and high dose cytarabine (phase B) in four Italian institutions. Eighty-nine per cent of patients were in Stage III-IV or had L3 leukemia. Complete remissions were 67/71 (94.4%), 24/25 (96%) in children, and 43/46 (93.5%) in adults. Toxic deaths were 3/71 (4.2%), all in adults. There were nine relapses (one in children, eight in adults), all but one observed early. After a median observation of 94 months (range 23-275), the Event-Free Survival rate is 92% in children and 71.7% in adults (P = 0.067). The 23 more recent adults received also rituximab, without differences in outcome as compared to patients who did not. Our experience confirms that such an intensive pediatric-derived chemotherapy is feasible and improves the long-term outcome of adults with advanced Burkitt lymphoma.
Collapse
|
34
|
Corazzelli G, Frigeri F, Russo F, Frairia C, Arcamone M, Esposito G, De Chiara A, Morelli E, Capobianco G, Becchimanzi C, Volzone F, Saggese M, Marcacci G, De Filippi R, Vitolo U, Pinto A. RD-CODOX-M/IVAC with rituximab and intrathecal liposomal cytarabine in adult Burkitt lymphoma and ‘unclassifiable’ highly aggressive B-cell lymphoma. Br J Haematol 2011; 156:234-44. [DOI: 10.1111/j.1365-2141.2011.08947.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
35
|
Affiliation(s)
- David C Linch
- Department of Haematology, Cancer Institute, University College London, 72 Huntley Street, London, UK.
| |
Collapse
|
36
|
Thomas DA, O'Brien S, Faderl S, Manning JT, Romaguera J, Fayad L, Hagemeister F, Medeiros J, Cortes J, Kantarjian H. Burkitt lymphoma and atypical Burkitt or Burkitt-like lymphoma: should these be treated as different diseases? Curr Hematol Malig Rep 2011; 6:58-66. [PMID: 21191675 PMCID: PMC4394740 DOI: 10.1007/s11899-010-0076-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Burkitt lymphoma (BL) is a mature B-cell non-Hodgkin lymphoma with an aggressive clinical course. Since the advent of short, intensive, multiagent chemoimmunotherapy regimens, it has carried a favorable prognosis. BL has been rather well characterized, whereas the other lymphomas morphologically resembling it are more heterogeneous. The cases classified as atypical BL/Burkitt-like lymphoma by the 2001 World Health Organization (WHO) Classification of Tumors of Hematopoietic and Lymphoid Tissue were thought to represent a continuum between BL and diffuse large B-cell lymphoma (DLBCL). The optimal therapeutic strategy for this provisional entity was not definitively established. However, recent incorporation of molecular genetic data into the 2008 WHO Classification has allowed further refinements with significant therapeutic implications, including the designation of a new provisional entity, "B-cell lymphoma, unclassifiable, with features intermediate between BL and DLBCL." This review presents a comprehensive overview of the previously designated provisional entity of atypical BL/BLL in conjunction with a detailed comparison with BL and DLBCL.
Collapse
Affiliation(s)
- Deborah A Thomas
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Abstract
PURPOSE The purpose of this study was to report the clinical and pathologic findings of three cases of rapid vision loss associated with fludarabine toxicity. METHODS A retrospective, single-center case series was conducted. Autopsies of the eyes from three cases were performed. RESULTS A 23-year-old man (Case 1) with systemic lupus erythematosus developed rapid and severe vision loss, generalized neurologic decline, and eventual death after administration of fludarabine before stem cell transplantation. A 48-year-old woman (Case 2) and a 60-year-old man (Case 3), both with metastatic melanoma, had similar courses after receiving fludarabine as part of a preparatory regimen before adoptive cell therapy. Fundus examination showed punctuate yellow flecks in the macula after visual decline in two cases. In all three cases, serum antiretinal antibodies were negative before and after treatment; electrophysiological testing showed markedly decreased B-waves; and pathologic analysis showed loss of retinal bipolar and ganglion cells, gliosis within the retina and optic nerve, and optic nerve atrophy. CONCLUSION Fludarabine toxicity can result in severe vision loss attributable to damage to retinal bipolar and ganglion cells. Although effective treatments are not known, care should be taken to consider fludarabine toxicity in patients who present with vision loss approximately 1 month after treatment.
Collapse
|
38
|
Abstract
Modern chemotherapy for childhood Burkitt lymphoma has its origins in Africa, where treatment evolved from one or two doses of single agents, which were curative in some patients, to combinations of non-cross-resistant drugs. Subsequently, in Europe and the United States, high-dose methotrexate, high-dose cytarabine, etoposide, and ifosfamide were found to be active in children with recurrent disease and were incorporated into primary therapy for patients with high-risk disease. These third-generation protocols produce overall cure rates around 90%. Therapy regimens for adults with Burkitt lymphoma have been developed by modifying second-generation pediatric protocols, and few investigators have used the third-generation pediatric regimens that include higher doses of methotrexate and additional agents. The weight of evidence strongly suggests that high-dose therapy with stem cell rescue in first remission cannot substitute for intensive therapy from the outset. Tolerance of intensive regimens by the elderly is a legitimate concern, but it seems appropriate to modify therapy only when necessary in individual patients. The value of rituximab and granulocyte colony-stimulating factor in patients undergoing intensive therapy (particularly the elderly) is worthy of further exploration. Because childhood diffuse large-B-cell leukemia (DLBCL) responds equally well to therapy for Burkitt lymphoma, more intensive therapy and intensive support might also give better results in at least a subset of adults with advanced DLBCL-perhaps defined on the basis of limited molecular profiling, which has provided new information about the categories of aggressive B-cell lymphomas.
Collapse
MESH Headings
- Adult
- Age Factors
- Anthracyclines/administration & dosage
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Murine-Derived
- Antimetabolites, Antineoplastic/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Burkitt Lymphoma/diagnosis
- Burkitt Lymphoma/drug therapy
- Burkitt Lymphoma/epidemiology
- Burkitt Lymphoma/genetics
- Burkitt Lymphoma/pathology
- Central Nervous System/pathology
- Child
- Diagnosis, Differential
- Drug Therapy/trends
- Granulocyte Colony-Stimulating Factor/administration & dosage
- Granulocyte Colony-Stimulating Factor/therapeutic use
- Humans
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Methotrexate/administration & dosage
- Randomized Controlled Trials as Topic/statistics & numerical data
- Rituximab
- Salvage Therapy
- Treatment Outcome
- Uganda/epidemiology
Collapse
Affiliation(s)
- Ian T Magrath
- International Network for Cancer Treatment & Research, INCTR at Institut Pasteur, Rue England 642, B1180, Brussels, Belgium.
| |
Collapse
|
39
|
Excellent immunological recovery following CODOX-M/IVAC, an effective intensive chemotherapy for HIV-associated Burkitt's lymphoma. AIDS 2010; 24:851-6. [PMID: 20124971 DOI: 10.1097/qad.0b013e3283301578] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE AND DESIGN : To retrospectively describe the recovery of cellular immunity and the clinical outcome of 30 patients with HIV-associated Burkitt's lymphoma (HIV-BL), who were treated with the intensive chemotherapy CODOX-M/IVAC and HAART as part of their standard care. PATIENTS AND METHODS : Seventy-three percent of the patients had high-risk disease, defined by stage, performance status, extranodal sites and lactate dehydrogenase. The median CD4 cell count at diagnosis of HIV-BL was 171/ml (range: 4-848) and the plasma HIV viral load was undetectable in five of 29 patients. RESULTS : Nine patients died during treatment (disease progression, three; toxicity, five; central nervous system lesion not biopsied, one). Response rate was 70% (complete response/complete response uncertain, 17; partial response, 4). After a median follow-up of 22 months (range: 6-72), 18 patients remain alive without disease progression. The 3-year overall survival and event-free survival were 52 and 75%, respectively. Viral load was undetectable in 88% and CD4 cell count more than 200/ml in 58% of patients assessed 6 months after completing chemotherapy, and in 87 and 80% at 12 months, respectively. CONCLUSION : The intensive regimen CODOX-M/IVAC, a feasible and effective chemotherapy, is associated with an excellent immunological recovery in patients with HIV-BL on HAART.
Collapse
|
40
|
Abstract
Burkitt lymphoma/leukemia (BL) has become a very curable mature B-cell neoplasm. Current standard regimens, focused on the unique characteristics of this disease, are composed of cyclical intensive chemotherapy and aggressive intrathecal prophylaxis. Using this approach, complete response rates of 80%-90% are routinely achieved, and survival is now approaching 80% with the addition of rituximab to these intensive regimens. Prophylactic cranial irradiation and prolonged maintenance have no proven benefit and are not recommended. The more widespread use of highly active antiretroviral therapy in the HIV patient with BL has allowed the use of similar aggressive therapies that are used for the non-HIV BL patients, with commensurate improvements in outcomes in this high-risk population. Future improvements for patients with BL could rely on standardization of gene expression profiling (to ensure more accurate diagnoses and prognostication of disease and to understand mechanisms of treatment resistance) and to develop novel biologically targeted approaches to treatment. The next generation of clinical trials to further improve survival will have the challenge of identifying high-risk patients who might be candidates for novel agents that could be incorporated into existing regimens with the goal of curing all patients with this disease.
Collapse
Affiliation(s)
- Vaishalee P Kenkre
- Section of Hematology/Oncology, University of Chicago and the University of Chicago Cancer Research Center, Chicago IL 60637, USA
| | | |
Collapse
|
41
|
Parker SM, Olteanu H, VanTuinen P, Lawton CA, Schultz CJ, Christians KK, Fenske TS. Follicular lymphoma transformation to dual translocated Burkitt-like lymphoma: improved disease control associated with radiation therapy. Int J Hematol 2009; 90:616-622. [PMID: 19937165 DOI: 10.1007/s12185-009-0444-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2009] [Revised: 09/16/2009] [Accepted: 10/29/2009] [Indexed: 10/20/2022]
Abstract
Dual translocated (or "dual hit") lymphomas are highly aggressive B cell neoplasms associated with an extremely poor prognosis. The optimal treatment for these lymphomas remains undefined. We present two cases of follicular lymphoma with transformation to Burkitt-like lymphoma. In both cases dual translocations involving both the bcl-2 and c-myc loci were present. Each patient underwent intensive induction immunochemotherapy followed by autologous stem cell transplantation and radiation therapy. The first patient received post-transplant mediastinal radiation and developed recurrence in multiple areas outside of the radiation field. The second patient received total body irradiation as part of the conditioning regimen, and is without recurrence 18 months after transplant, and 24 months after diagnosis of the dual translocated lymphoma. We review dual translocation B cell lymphoma in the setting of transformation from follicular lymphoma, and suggest a potential role for total body irradiation in the management of this highly aggressive non-Hodgkin lymphoma.
Collapse
Affiliation(s)
- Stacey M Parker
- Department of Internal Medicine, The Medical College of Wisconsin, Milwaukee, WI, USA
| | - Horatiu Olteanu
- Department of Pathology, The Medical College of Wisconsin, Milwaukee, WI, USA
| | - Peter VanTuinen
- Department of Pathology, The Medical College of Wisconsin, Milwaukee, WI, USA
| | - Colleen A Lawton
- Department of Radiation Oncology, The Medical College of Wisconsin, Milwaukee, WI, USA
| | - Christopher J Schultz
- Department of Radiation Oncology, The Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Timothy S Fenske
- Division of Neoplastic Diseases and Related Disorders, Medical College of Wisconsin, 9200 W. Wisconsin Avenue, Milwaukee, WI, 53226, USA.
| |
Collapse
|
42
|
Thomas DA, O'Brien S, Kantarjian HM. Monoclonal antibody therapy with rituximab for acute lymphoblastic leukemia. Hematol Oncol Clin North Am 2009; 23:949-71, v. [PMID: 19825447 PMCID: PMC4458386 DOI: 10.1016/j.hoc.2009.07.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Significant advances have been achieved in the treatment of acute lymphoblastic leukemia (ALL) with the incorporation of targeted therapy agents. Targeting leukemia surface antigens with monoclonal antibodies is another promising strategy. This article comprehensively reviews available data regarding the use of rituximab for the treatment of Burkitt-type leukemia/lymphoma and CD20-positive precursor B-cell ALL. The incorporation of rituximab into frontline chemotherapy regimens for Burkitt-type leukemia/lymphoma appears to improve outcome. Preliminary data regarding the use of rituximab in frontline therapy for CD20- positive precursor B-cell ALL suggest its use may also be beneficial, particularly for the younger subsets.
Collapse
Affiliation(s)
- Deborah A Thomas
- Department of Leukemia, University of Texas M D Anderson Cancer Center, 1515 Holcombe Blvd, Unit 428, Houston, TX 77030, USA.
| | | | | |
Collapse
|
43
|
Herrlinger U, Glantz M, Schlegel U, Gisselbrecht C, Cavalli F. Should Intra-cerebrospinal Fluid Prophylaxis Be Part of Initial Therapy for Patients With Non-Hodgkin Lymphoma: What We Know, and How We Can Find Out More. Semin Oncol 2009; 36:S25-34. [DOI: 10.1053/j.seminoncol.2009.05.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
44
|
Kelly JL, Toothaker SR, Ciminello L, Hoelzer D, Holte H, LaCasce AS, Mead G, Thomas D, Van Imhoff GW, Kahl BS, Cheson BD, Magrath IT, Fisher RI, Friedberg JW. Outcomes of patients with Burkitt lymphoma older than age 40 treated with intensive chemotherapeutic regimens. CLINICAL LYMPHOMA & MYELOMA 2009; 9:307-10. [PMID: 19717381 PMCID: PMC2909640 DOI: 10.3816/clm.2009.n.060] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Burkitt lymphoma is a highly curable disorder when treated with modern intensive chemotherapy regimens. The majority of adult patients with Burkitt lymphoma in the United States are over age 40 years. Older patients have historically been underrepresented in published clinical trials of modern intensive therapy, and the outcome of these patients has not been systematically reported. We therefore obtained and analyzed primary data from 14 Burkitt lymphoma treatment series and confirmed that older patients (age > 40 years) are underrepresented in the literature. Historically inferior outcomes of this age subgroup have improved substantially over time. We conclude that (1) modern intensive chemotherapy regimens should remain the standard of care for patients > age 40 with Burkitt lymphoma; (2) selected patients > age 40 now have highly favorable outcomes; and (3) future studies should include formal analysis of this subgroup of patients.
Collapse
Affiliation(s)
- Jennifer L Kelly
- James P. Wilmot Cancer Center, University of Rochester, Rochester, NY 14642, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Kujawski LA, Longo WL, Williams EC, Turman NJ, Brandt N, Mosher DF, Eickhoff JC, Kahl BS. A 5-Drug Regimen Maximizing the Dose of Cyclophosphamide is Effective Therapy for Adult Burkitt or Burkitt-like Lymphomas. Cancer Invest 2009; 25:87-93. [PMID: 17453819 DOI: 10.1080/07357900701205507] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Burkitt lymphoma (BL) and Burkitt-like lymphomas (BLL) are clinically and biologically aggressive B-cell malignancies. Brief-duration, high intensity multidrug regimens with central nervous system (CNS) prophylaxis have proven to be effective, with published series of adult patients documenting complete response (CR) rates of 80 to 100 percent and 2-year event-free survival (EFS) rates ranging from 60 to 90 percent. Based upon the known sensitivity of BL to cyclophosphamide and favorable results reported from the Dana Farber Cancer Center using high-dose CHOP in diffuse aggressive lymphomas, we tested a regimen designed to maximize the administered dose of cyclophosphamide while eliminating other agents commonly used in BL protocols. Eleven patients with Burkitt or Burkitt-like lymphoma were treated with 4 cycles of a 5-drug regimen, called high-dose CHOP, which contains a cyclophosphamide dose of 4 gm/m2 with each cycle. Intrathecal methotrexate and midcycle high-dose methotrexate were added as CNS prophylaxis. Ten patients achieved a complete response (91 percent) and with a median follow up of 38 months, the 3-year EFS is 64 percent and the 3-year overall survival (OS) is 72 percent. Three patients recurred after the achievement of a CR. Treatment-related toxicities included myelosuppression, neutropenic fevers/infections, and tumor lysis syndrome requiring hemodialysis in 2 patients. There were no treatment-related deaths and none of the patients had to discontinue therapy secondary to toxicity. In conclusion, the high-dose CHOP with midcycle methotrexate regimen produces response rates and EFS rates comparable to other regimens, with an acceptable toxicity profile. Utilization of high dose cyclophosphamide may eliminate the need for several other agents in Burkitt lymphoma regimens.
Collapse
Affiliation(s)
- Lisa A Kujawski
- University of Wisconsin Hospitals and Clinic, University of Wisconsin Comprehensive Cancer Center, Madison, Wisconsin 53792, USA
| | | | | | | | | | | | | | | |
Collapse
|
46
|
Choi KA, Lee JE, Kim YG, Kim DJ, Kim K, Ko YH, Oh HY, Kim WS, Huh W. Efficacy of continuous venovenous hemofiltration with chemotherapy in patients with Burkitt lymphoma and leukemia at high risk of tumor lysis syndrome. Ann Hematol 2008; 88:639-45. [DOI: 10.1007/s00277-008-0642-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2007] [Accepted: 11/05/2008] [Indexed: 10/21/2022]
|
47
|
|
48
|
Abstract
The malignant lymphomas, including both Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL), represent a diverse group of diseases that arise from a clonal proliferation of lymphocytes. Each of the more than 30 unique types of lymphoma is a disease with a distinct natural history. This biologic heterogeneity gives rise to marked differences among the lymphomas with respect to epidemiology, pathologic characteristics, clinical presentation, and optimal management. This article emphasizes the principles of diagnosis, including appropriate pathologic evaluation and staging considerations, and focuses on the clinical presentation, staging, and optimal management strategies for the most common types of lymphoma.
Collapse
Affiliation(s)
- Matthew J Matasar
- Medical Oncology/Hematology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
| | | |
Collapse
|
49
|
To protect and defend: central nervous system prophylaxis in patients with non-Hodgkinʼs lymphoma. Curr Opin Oncol 2008; 20:495-501. [DOI: 10.1097/cco.0b013e32830b829e] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
50
|
Abstract
PURPOSE OF REVIEW Despite improvements in the achievement of complete remission and progress in the supportive care of adults with acute lymphoblastic leukemia during the last decade, the majority of patients have eventually relapsed with overall survival in adult acute lymphoblastic leukemia of only 30-40%. However, the recent approach of adapting therapy according to biologic features appears to be resulting in significant progress for specific subsets of adults with acute lymphoblastic leukemia. RECENT FINDINGS The present review highlights some of these new risk-adapted approaches focusing on recent advances in treatment of Philadelphia chromosome positive acute lymphoblastic leukemia and mature B-cell acute lymphoblastic leukemia using biologically targeted therapies, and new approaches to treatment of acute lymphoblastic leukemia in older adolescents and young adults, adopting therapeutic strategies employed in the successful treatment of children with acute lymphoblastic leukemia. A recent study that examines the role of allogeneic stem cell transplant for adults with acute lymphoblastic leukemia in first remission will also be reviewed. SUMMARY The subset-specific approach to therapy of adult acute lymphoblastic leukemia is beginning to result in promising improvements in survival. Future improvements in survival of adults with acute lymphoblastic leukemia will depend on participation in large cooperative group trials using biologically defined protocols for this relatively rare and heterogeneous group of diseases.
Collapse
|