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Abstract
PURPOSE OF REVIEW Burkitt's lymphoma and its leukemic form (Burkitt cell acute lymphoblastic leukemia) are a highly aggressive disease. We review the classification, clinical presentation, histology, cytogenetics, and the treatment of the disease. RECENT FINDINGS Burkitt's lymphoma might be associated with tumor lysis syndrome which is a potentially fatal complication that occurs spontaneously or upon initiation of chemotherapy. Major improvements were made in the treatment of pediatric and adults population using short-course dose-intensive chemotherapy regimens, usually 1 week after a prephase induction. Addition of Rituximab to chemotherapy has become a standard of care. Relapsed/refractory disease has a very poor prognosis and the benefit from autologous/allogeneic hematopoietic stem cell transplant remains uncertain. Rituximab-based short-course dose-intensive chemotherapy is the standard of care of Burkitt's lymphoma even in the immunodeficiency-related form.
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Chen RW, Li H, Bernstein SH, Kahwash S, Rimsza LM, Forman SJ, Constine L, Shea TC, Cashen AF, Blum KA, Fenske TS, Barr PM, Phillips T, Leblanc M, Fisher RI, Cheson BD, Smith SM, Faham M, Wilkins J, Leonard JP, Kahl BS, Friedberg JW. RB but not R-HCVAD is a feasible induction regimen prior to auto-HCT in frontline MCL: results of SWOG Study S1106. Br J Haematol 2016; 176:759-769. [PMID: 27992063 DOI: 10.1111/bjh.14480] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 10/11/2016] [Indexed: 11/28/2022]
Abstract
Aggressive induction chemotherapy followed by autologous haematopoietic stem cell transplant (auto-HCT) is effective for younger patients with mantle cell lymphoma (MCL). However, the optimal induction regimen is widely debated. The Southwestern Oncology Group S1106 trial was designed to assess rituximab plus hyperCVAD/MTX/ARAC (hyperfractionated cyclophosphamide, vincristine, doxorubicin and dexamethasone, alternating with high dose cytarabine and methotrexate) (RH) versus rituximab plus bendamustine (RB) in a randomized phase II trial to select a pre-transplant induction regimen for future development. Patients had previously untreated stage III, IV, or bulky stage II MCL and received either 4 cycles of RH or 6 cycles of RB, followed by auto-HCT. Fifty-three of a planned 160 patients were accrued; an unacceptably high mobilization failure rate (29%) on the RH arm prompted premature study closure. The estimated 2-year progression-free survival (PFS) was 81% vs. 82% and overall survival (OS) was 87% vs. 88% for RB and RH, respectively. RH is not an ideal platform for future multi-centre transplant trials in MCL. RB achieved a 2-year PFS of 81% and a 78% MRD negative rate. Premature closure of the study limited the sample size and the precision of PFS estimates and MRD rates. However, RB can achieve a deep remission and could be a platform for future trials in MCL.
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Affiliation(s)
| | - Hongli Li
- SWOG Statistical Center, Seattle, WA, USA
| | - Steven H Bernstein
- James P. Wilmot Cancer Center, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | | | - Lisa M Rimsza
- University of Arizona, Tucson, AZ (previous), USA.,Mayo Clinic, Scottsdale, AZ (current), USA
| | | | - Louis Constine
- University of Rochester, James P. Wilmot Cancer Center, Rochester, NY, USA
| | - Thomas C Shea
- Division of Hematology/Oncology, UNC School of Medicine, Chapel Hill, NC, USA
| | - Amanda F Cashen
- Division of Oncology, Department of Medicine, Washington University School of Medicine, Saint Louis, MO, USA
| | - Kristie A Blum
- Division of Hematology, Ohio State University, Columbus, OH, USA
| | - Timothy S Fenske
- Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Paul M Barr
- Wilmot Cancer Institute, University of Rochester, Rochester, NY, USA
| | | | | | - Richard I Fisher
- Fox Chase Cancer Center/Temple University School of Medicine, Philadelphia, PA, USA
| | - Bruce D Cheson
- Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC, USA
| | | | - Malek Faham
- Adaptive Biotechnologies Corp, South San Francisco, CA, USA
| | | | - John P Leonard
- Department of Hematology/Oncology, Weill Cornell Medical College, New York, NY, USA
| | - Brad S Kahl
- University of Wisconsin, Madison (previous), WI, USA.,Washington University School of Medicine in St. Louis, St. Louis, MO (current), USA
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