Chemoimmunotherapy with hyper‐CVAD plus rituximab for the treatment of adult Burkitt and Burkitt‐type lymphoma or acute lymphoblastic leukemia

• Published in: Cancer Vol. 106; no. 7; pp. 1569 - 1580
• Main Authors: Thomas, Deborah A., Faderl, Stefan, O'Brien, Susan, Bueso‐Ramos, Carlos, Cortes, Jorge, Garcia‐Manero, Guillermo, Giles, Francis J., Verstovsek, Srdan, Wierda, William G., Pierce, Sherry A., Shan, Jianqin, Brandt, Mark, Hagemeister, Fredrick B., Keating, Michael J., Cabanillas, Fernando, Kantarjian, Hagop
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.04.2006; Wiley-Liss
• Subjects: acute lymphoblastic leukemia; adult Burkitt lymphoma; Antibodies, Monoclonal - therapeutic use; Antibodies, Monoclonal, Murine-Derived; Antineoplastic agents; Antineoplastic Agents - therapeutic use; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Burkitt Lymphoma - drug therapy; B‐ALL; chemoimmunotherapy; Combined Modality Therapy; Combined treatments (chemotherapy of immunotherapy associated with an other treatment); Cyclophosphamide - administration & dosage; Dexamethasone - administration & dosage; Doxorubicin - administration & dosage; Drug Administration Schedule; Female; Humans; hyper‐CVAD; Immunotherapy; Infusions, Intravenous; Male; Medical sciences; Middle Aged; Pharmacology. Drug treatments; Precursor Cell Lymphoblastic Leukemia-Lymphoma - drug therapy; Rituximab; Survival Analysis; Treatment Outcome; Tumors; Vincristine - administration & dosage; Antineoplastic agent; B-ALL; chemoimmunotherapy; BL; Monoclonal antibody; Glucocorticoid; Doxorubicin; Alkaloid; Isomerases; Cancerology; Lymphoproliferative syndrome; Immunotherapy; Anticytokine; Adult; Acute lymphocytic leukemia; Antimitotic; Human; Corticosteroid; DNA topoisomerase (ATP-hydrolysing); Drug combination; Dexamethasone; Enzyme; Acute; Burkitt lymphoma; Enzyme inhibitor; Acute leukemia; Rituximab; Malignant hemopathy; Non Hodgkin lymphoma; Vincristine; Fractionated dose; Infection; Alkylating agent; Antibiotic; Oxazaphosphinane derivatives; Chemotherapy; Cyclophosphamide; acute lymphoblastic leukemia; Nitrogen mustard; Viral disease; adult Burkitt lymphoma; Anthracyclins; Combined treatment; Therapeutic protocol; hyper-CVAD
• DOI: 10.1002/cncr.21776
• ISSN: 0008-543X

BACKGROUND Adult Burkitt‐type lymphoma (BL) and acute lymphoblastic leukemia (B‐ALL) are rare entities composing 1% to 5% of non‐Hodgkin lymphomas NHL) or ALL. Prognosis of BL and B‐ALL has been poor with conventional NHL or ALL regimens, but has improved with dose‐intensive regimens. METHODS To evaluate the addition of rituximab, a CD20 monoclonal antibody, to intensive chemotherapy in adults with BL or B‐ALL, 31 patients with newly diagnosed BL or B‐ALL received the hyper‐fractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone (hyper‐CVAD) regimen with rituximab. Their median age was 46 years; 29% were 60 years or older. Rituximab 375 mg/m2 was given on Days 1 and 11 of hyper‐CVAD courses and on Days 1 and 8 of methotrexate and cytarabine courses. RESULTS Complete remission (complete response [CR]) was achieved in 24 of 28 (86%) evaluable patients; 3 had a partial response, and 1 had resistant disease. There were no induction deaths. The 3‐year overall survival (OS), event‐free survival, and disease‐free survival rates were 89%, 80%, and 88%, respectively. Nine elderly patients achieved CR with all of them in continuous CR (except 1 death in CR from infection), with a 3‐year OS rate of 89%. Multivariate analysis of current and historical (those treated with hyper‐CVAD alone) groups identified age and treatment with rituximab as favorable factors. CONCLUSIONS The addition of rituximab to hyper‐CVAD may improve outcome in adult BL or B‐ALL, particularly in elderly patients. Cancer 2006. © 2006 American Cancer Society. The addition of rituximab to hyper‐CVAD may improve outcome in adult Burkitt lymphoma and acute lymphoblastic leukemia, particularly in elderly patients.