Treatment of Burkitt's tumor with cyclophosphamide

Abstract

The results of therapy of 57 previously untreated patients with Burkitt's tumor seen over a 2‐year period at the Lymphoma Treatment Center, Kampala, Uganda are reported. Thirty‐seven patients were randomized to either a single dose or multiple doses of intravenous cyclophosphamide (CTX) 40 mg/kg. Ten of 11 patients with localized (stage I‐II) disease have continued in complete remission regardless of drug schedule. Among stage III patients, remission duration was shorter and relapse was more common in the group receiving a single dose. Intrathecal chemotherapy using methotrexate and cytosine arabinoside was successfully employed in the management of 12 patients with malignant cells in the cerebrospinal fluid. However, more aggressive and prolonged therapy is indicated to prevent relapse. Secondary chemotherapy using vincristine, methotrexate, and cytosine arabinoside produced complete responses in 90% of patients relapsing on multiple‐dose CTX. This study showed that: 1. single doses of CTX are capable of inducing long remissions in patients with localized disease; 2. multiple doses of CTX do not appear harmful in the maintenance of remissions in patients with localized tumors; 3. multiple doses of CTX result in fewer relapses and longer remissions in patients with visceral (stage III) disease compared with a single‐dose regimen; 4. the prognosis is improved in stage III patients who undergo surgical reduction of tumor bulk prior to chemotherapy; and 5. recognition and aggressive treatment of patients in relapse, particularly those with central nervous system involvement, are important considerations in the long term management of Burkitt's tumor.

Surgical Reduction of Tumour Bulk in Management of Abdominal Burkitt's Lymphoma

“…Remission and survival rates were similar whichever form of therapy was used (Ziegler, 1972). Patients with meningeal tumour infiltration were treated with intrathecally adminis-*tered drugs (Ziegler and Bluming, 1971).…”

Pharmacokinetics of Anticancer Drugs in Children

“…It is used in combination for the treatment of non-Hodgkin's lymphoma, Hodgkin's disease and acute leukaemias (Ferobach et al 1966;Tan et al 1975a;Wollner et al 1975). As a single agent, it is potentially curative in Burkitt's lymphoma (Ziegler et al 1970). Activity has also been demonstrated in sarcomas of soft tissue and bone, neuroblastoma, and germ cell tumours Sutow & Sullivan 1962;Thurman et al 1964;Wilbur et al 1975).…”

Burkitt's lymphoma in Japan: Clinicopathological features of twenty-two patients.

“…Three patients were older-19, 26 and 29 years. All patients were staged according to the clinical staging criteria by Ziegler et al (1970). Of the 22 cases, 5 (23%) were in stage I, 8 (36%) were in stage II, 6 (27%) were in stage III and 3 (14%) were in stage IV.…”

“…However, Japanese patients were generally refractory to cytotoxic drugs, including cyclophosphamide, vincristine, methotrexate and cytosine arabinoside, and had a poor prognosis, regardless of the initial stage of the disease. Thus, the mean survival of Japanese patients was short as compared to those of African and American cases (Ziegler et al 1970;Ziegler 1972;Arseneau et al 1975;Nkrumah and Perkins 1976). The explanation for the poor prognosis may be racial, environmental and immunologic factors.…”