BACKGROUNDIn the era of highly active antiretroviral therapy (HAART), standardâdose chemotherapy for human immunodeficiency virus (HIV)âassociated diffuse large Bâcell lymphoma is becoming the standard of care. In contrast, the safety and efficacy of intensive regimens have not been established for Burkitt lymphoma (BL), a highly aggressive lymphoma for which moderateâdose chemotherapy is substandard in the HIVânegative population.METHODSTo evaluate the feasibility of intensive chemotherapy in HIVâassociated BL, the authors retrospectively reviewed 14 HIVâpositive adults with BL treated at their center between 1988 and 2000. Eight patients were treated between 1996 and 2000 with cyclophosphamide, doxorubicin, highâdose methotrexate/ifosfamide, etoposide, and highâdose cytarabine (CODOXâM/IVAC), one of the currently preferred intensiveâdose chemotherapy regimens for BL. Six received other chemotherapy. Outcomes were compared with those of 24 HIVânegative adult patients with BL who had similar patient characteristics and were treated concomitantly (13 with CODOXâM/IVAC; 11 with other regimens).RESULTSOf the 14 HIVâpositive patients, 63% had a complete response after CODOXâM/IVAC treatment, compared with 67% of patients receiving other chemotherapy. The 2âyear eventâfree survival (EFS) rates were 60% and 60% after CODOXâM/IVAC or other regimens, respectively. Similar outcomes were seen despite the fact that 88% of CODOXâM/IVACâtreated HIVâpositive patients had Stage IV disease, compared with oneâthird of HIVâpositive patients treated with other chemotherapy. HIV status did not adversely affect longâterm EFS independent of the treatment regimen (P = 0.88). When EFS was evaluated according to chemotherapy regimen independent of HIV status, CODOXâM/IVAC was found to be associated with improved EFS (P = 0.05) in all patients, and particularly those at high risk. HIVâpositive patients treated with CODOXâM/IVAC tolerated chemotherapy well with similar rates of myelosuppression and infectious complications as HIVânegative patients.CONCLUSIONSThe current nonrandomized retrospective study suggested that intensive chemotherapy with CODOXâM/IVAC is feasible and well tolerated in HIVâpositive adults with BL. In the postâHAART era, intensive chemotherapy such as CODOXâM/IVAC may be appropriate in all adult patients with BL, and especially those with poor prognostic factors, regardless of HIV status. Cancer 2003;98:1196â205. © 2003 American Cancer Society.DOI 10.1002/cncr.11628