Short intensive sequential therapy followed by autologous stem cell transplantation in adult Burkitt, Burkitt-like and lymphoblastic lymphoma

Imhoff, Gustaaf W. van; Holt, Bronno van der; MacKenzie, Marius; Ossenkoppele, Gert J.; Wijermans, P. W.; Kramer, Mark H. H.; Veer, Mars B. van ‘t; Schouten, Harry C.; Kooy, Marinus van Marwijk; Oers, Marinus H. J. van; Raemaekers, John; Sonneveld, Pieter; Meulendijks, L A M H; Kluin, Philip M.; Kluin-Nelemans, Hanneke C.; Verdonck, Leo F.

doi:10.1038/sj.leu.2403733

Cited by 53 publications

(36 citation statements)

References 41 publications

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“…Another short intensive chemotherapy regimen obtained an EFS of 72.7%, but half of patients were in Stage I-II [8]. The results of other various short duration/ dose intensive regimens appear not superior, with EFS ranging from 50 to 70% [6,7,14,15].…”

Section: Discussionmentioning

confidence: 91%

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

et al. 2011

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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 5 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. Am. J. Hematol. 87:22-25, 2012. V V C 2011 Wiley Periodicals, Inc. IntroductionFifty years after its description [1] the optimal treatment of adult sporadic Burkitt lymphoma/leukemia (BL) still represents a matter of debate [2]. Standard chemotherapy such as CHOP [3] or adult ALL regimens [4] are clearly inadequate for treating BL, with a long term survival ranging from 0 to 30%. By contrast, the employment of intensive pediatric regimens in adult patients determined better results [5][6][7][8]. The HyperCVAD regimen, developed at the M.D. Anderson Cancer Center, confirmed a good activity in BL patients. However, the authors observed that patients older than 60 years clearly had an inferior outcome, with a survival rate of only 17% [9]. The addition of Rituximab and the improvement in supportive care measures possibly contributed to the achievement of similar outcomes in older and younger adults [10].In 1997, we reported a monocentric experience of 21 patients (8 adults and 13 children) treated with the intensive short-term pediatric-derived chemotherapy regimen POG 8617 [11], demonstrating that the outcome in adults was not significantly different than in children [12]. Fourteen years after our original report, we present here the longterm results of the same chemotherapy regimen employed in a multicenter experience recruiting a larger cohort of 71 consecutive BL patients. Of note, 48% of adult patients were older than 40 years and Rituximab was added to chemotherapy in the more recently enrolled adult patients. With a median follow-up of about 8.5 years, we confirm that this intensive pediatric-derived regimen is safe and improves the outcome of adults with advanced BL.

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Section: Discussionmentioning

confidence: 91%

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

et al. 2011

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“…22 The HOVON group has demonstrated the feasibility and efficacy of consolidating responses to aggressive, intensive chemotherapy with high dose BEAM (carmustine, etoposide, cytarabine and melphalan) and autologous stem cell support. 23 In their study, which enrolled patients with a median age of 36 years, the 5-year event-free survival estimate was 73%.…”

Section: Therapy Of 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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“…Patients with lymphoblastic lymphomas can be consolidated with an autologous HSCT in first CR, as indicated by some phase II trials. 58 Allogeneic HSCT can eventually be considered in young adults in first CR. 59 Burkitt's lymphoma patients with bad prognostic features at diagnosis can also be consolidated with an autologous HSCT.…”

Section: T-cell Lymphomasmentioning

confidence: 99%

“…59 Burkitt's lymphoma patients with bad prognostic features at diagnosis can also be consolidated with an autologous HSCT. 58 Allogeneic HSCT can be considered for patients in CR2.…”

Section: T-cell Lymphomasmentioning

confidence: 99%

Allogeneic and autologous transplantation for haematological diseases, solid tumours and immune disorders: current practice in Europe 2009

Ljungman

Bregni

Brüne

et al. 2009

Bone Marrow Transplant

319

228

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The European Group for Blood and Marrow Transplantation regularly publishes special reports on the current practice of haematopoietic SCT for haematological diseases, solid tumours and immune disorders in Europe. Major changes have occurred since the first report was published. HSCT today includes grafting with allogeneic and autologous stem cells derived from BM, peripheral blood and cord blood. With reduced-intensity conditioning regimens in allogeneic transplantation, the age limit has increased, permitting the inclusion of older patients. New indications have emerged, such as autoimmune disorders and AL amyloidosis for autologous HSCT and solid tumours, myeloproliferative syndromes and specific subgroups of lymphomas for allogeneic transplants. The introduction of alternative therapies, such as imatinib for CML, has challenged well-established indications. An updated report with revised tables and operating definitions is presented

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Short intensive sequential therapy followed by autologous stem cell transplantation in adult Burkitt, Burkitt-like and lymphoblastic lymphoma

Cited by 53 publications

References 41 publications

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

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

Burkitt Lymphoma in Adults

Allogeneic and autologous transplantation for haematological diseases, solid tumours and immune disorders: current practice in Europe 2009

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