Intensive chemotherapy regimen (LMB86) for St Jude stage IV AIDS-related Burkitt lymphoma/leukemia: a prospective study

Galicier, Lionel; Fieschi, Claire; Borie, Raphaël; Meignin, Véronique; Daniel, Marie‐Thérèse; Gérard, Laurence; Oksenhendler, Éric

doi:10.1182/blood-2006-10-051771

Cited by 67 publications

(42 citation statements)

References 45 publications

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“…32 For example, the LMB86 regimen (escalated CHOPbased therapy, with consolidation cytarabine and etoposide) has recently been evaluated in 63 HIV-infected patients with Murphy stage IV (bone marrow and/or CNS involvement) Burkitt lymphoma and a median age of 40. 33 At diagnosis of Burkitt lymphoma, the median CD4 count was 239. Forty-four patients (70%) achieved complete response, and only 7 treatment-related deaths occurred despite significant cytopenias observed in all patients during therapy.…”

Section: Hiv-positive Burkitt Lymphoma In Adultsmentioning

confidence: 99%

Burkitt Lymphoma in Adults

Perkins

Friedberg²

2008

Hematology

103

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This review will begin with a detail of the revision of the WHO classification, and pathological definitions of Burkitt lymphoma. Over the past several years, molecular understanding of Burkitt lymphoma has improved significantly. Using gene expression profiling, a genomic “signature” of Burkitt lymphoma may be identified, that has fidelity beyond c-myc expression, and the presence of the classical t(8;14). Then, evaluation and therapy of the adult patient with Burkitt lymphoma will be reviewed. Relatively few data exist on optimal therapy of the adult patient with Burkitt lymphoma. Principles of therapy should include high doses of alkylating agents, frequent administration of chemotherapy, and attention to central nervous system (CNS) prophylaxis with high doses of systemic chemotherapy, intrathecal therapy, or both. The outcome of adult patients with Burkitt lymphoma, particularly those over 40 years of age, is inferior to the outcome of younger patients, but may be improving over the past few years. Results from an international collaborative effort, which are helpful in evaluating results of Burkitt lymphoma therapy in adults, will be presented. HIV-associated Burkitt lymphoma, and elderly patients with Burkitt lymphoma, comprise special clinical situations that will be also covered in this review.

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Section: Hiv-positive Burkitt Lymphoma In Adultsmentioning

confidence: 99%

Burkitt Lymphoma in Adults

Perkins

Friedberg²

2008

Hematology

103

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“…16 Analyzing Deaths during induction period (28%) were mostly following COPADM1 course, probably due to accumulated hematologic toxicity of the two courses given in short duration, while high dose Ara-C and related toxicity was the main cause of death during consolidation (11%) in group C patients. Similarly, life threatening infections were reported during COPADM1 and CYVE 5,25 . Other causes of death were tumor progression in 10% of the patients.…”

Section: Discussionmentioning

confidence: 99%

Pediatric mature B-cell non Hodgkin lymphoma treatment with LMB-96 protocol. The Children Cancer Hospital Egypt experience

Rahman

Moussa

Sedky

et al. 2015

Int J Cancer Ther Oncol

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Original ArticleAbstract Purpose: Burkitt lymphoma (BL) is a highly aggressive mature B-cell non-Hodgkin lymphoma (NHL) and is the fastest growing human tumor. The outcome of childhood NHL has improved steadily over the past decades through the use of intensive sequential multi-agent chemotherapy regimens. Methods: A retrospective study having all patients 18 years old or younger diagnosed with mature B cell NHL and treated at Children Cancer Hospital Egypt (CCHE). All children were treated according to the modified (LMB 96) protocol during the period between July 2007 and December 2012. Patients were followed up till June 2013. Results: Three hundred and seventy-seven patients were diagnosed with mature B cell NHL and received the LMB96 treatment protocol. The majorities were males (76.4%) with a median age of 5.3 years, and ranged from 0.1-18.0 years. The median follow-up period was 28.2 months (range 0.9-72 months). Burkitt lymphoma was the most predominant pathologic subtype (79.6%, n = 300), and abdominal mass as a primary site was the most common presentation (71.3%). Twenty seven patients (7.2%) were treated as group A, 268 (71.0%) as group B, and 82 (21.8%) patients as high risk group C. Seventy-one (18.8%) patients suffered adverse events. Major adverse events were early deaths in 17 patients (4.5%), death during induction chemotherapy seen in 18 patients (4.7%), and during maintenance therapy in 7 patients (1.8%), tumor progression in 19 patients (5.0%), and relapse in 10 patients (3.7%). Sixty-three patients (16.7%) died during the study period. The main causes of death were tumor lysis syndrome (TLS) in 25.3%, and severe sepsis during chemotherapy in 41.3% of the patients. The 3 years OS and EFS were 83.3% and 80.4% respectively for the whole groups of patients. OS and EFS were 100% for group A, and 87.5%±3.9% and 85.9±4.3% for group B. For group C BM + /CNS -patients, OS was 55.62%±15.8%, and EFS of 53.8%±15.6%. For BM + /CNS + patients, OS and EFS were 63.2%±21.76% and 57.9%±22.1% respectively. BM -/CNS + patients had OS 72.4%±18.8% and EFS 67.6%±19.7% at 36 months. Conclusion: TLS and chemotherapy related toxicity remains a major challenge affecting the outcome of pediatric mature B cell NHL. We identified bone marrow involvement as a risk factor affecting treatment outcome. Aggressive supportive care measures are mandatory to avoid unacceptable high toxicity related mortality.

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“…The change in attitude is partly due to the efficacy of modern anti-retroviral therapy in AIDS, with these drugs generally being given concurrently with intensive chemotherapy. In addition, there has been the realization discussed above that BL patients are not the most severely immuno-suppressed, although a low CD4 count remains a poor prognostic factor (Galicier et al, 2007). One study compared the toxicity of an intensive immuno-chemotherapy regimen incorporating rituximab in HIV-infected and non-infected patients, and although there was more mucositis and more severe infections in the HIV positive patients, there was no significant difference in survival (Oriol et al, 2008).…”

Section: Immunodeficiency-associated Blmentioning

confidence: 99%

“…One study compared the toxicity of an intensive immuno-chemotherapy regimen incorporating rituximab in HIV-infected and non-infected patients, and although there was more mucositis and more severe infections in the HIV positive patients, there was no significant difference in survival (Oriol et al, 2008). In the series reported by Galicier et al (2007), using the LMB86 regimen, 70% of 63 HIV-infected patients with Murphy Stage IV disease achieved a CR and the estimated OS at 2 years was 47%. A comparison of BL patients treated in California suggested that the relative mortality rate at 2 years was 1AE3 (1AE0-1AE7) in HIV-infected compared to non-infected individuals (Chao et al, 2010).…”

Section: Immunodeficiency-associated Blmentioning

confidence: 99%

Burkitt lymphoma in adults

Linch

2011

Br J Haematol

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SummaryThe diagnosis of Burkitt Lymphoma (BL) and B‐cell lymphomas unclassifiable with features intermediate between Diffuse Large B‐cell Lymphoma and BL (BLU) in adults remains problematic even with immunophenotyping and MYC gene analysis. Gene expression profiling may improve categorization but is not routinely available. BL and its variants should be treated with specific regimens incorporating intensive courses of chemotherapy with fractionated alkylating agents and cell cycle phase‐specific agents that readily cross the blood brain barrier. Subsequent courses should be given as soon as haematological recovery occurs, with the whole course completed within a few months. A number of regimens have been developed that encompass these principles but there have been no comparative randomized trials. The results from several studies suggest that the addition of rituximab is highly efficacious and this may be particularly valuable in older patients. It is usual to employ ‘risk‐adapted’ strategies in the treatment of BL but these must be continually re‐evaluated, and ‘response‐adapted’ approaches should be explored. The role of transplantation is limited and largely confined to autologous transplants in patients who only achieve a partial response on front‐line therapy or who have a chemosensitive relapse. Further advances will be greatly facilitated by randomized trials, which will require international collaboration.

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Intensive chemotherapy regimen (LMB86) for St Jude stage IV AIDS-related Burkitt lymphoma/leukemia: a prospective study

Abstract: Prognosis of acquired immunodeficiency syndrome (AIDS)-related non-Hodgkin

Cited by 67 publications

References 45 publications

Burkitt Lymphoma in Adults

Burkitt Lymphoma in Adults

Pediatric mature B-cell non Hodgkin lymphoma treatment with LMB-96 protocol. The Children Cancer Hospital Egypt experience

Burkitt lymphoma in adults

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