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

• Published in: Blood Vol. 110; no. 8; pp. 2846 - 2854
• Main Authors: Galicier, Lionel, Fieschi, Claire, Borie, Raphael, Meignin, Véronique, Daniel, Marie-Thérèse, Gérard, Laurence, Oksenhendler, Eric
• Format: Journal Article
• Language: English
• Published: Washington, DC Elsevier Inc 15.10.2007; The Americain Society of Hematology
• Subjects: Adult; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Antiretroviral Therapy, Highly Active; Biological and medical sciences; Burkitt Lymphoma - drug therapy; Burkitt Lymphoma - mortality; Burkitt Lymphoma - pathology; CD4 Lymphocyte Count; Cyclophosphamide - administration & dosage; Cytarabine - administration & dosage; Disease-Free Survival; Doxorubicin - administration & dosage; Etoposide - administration & dosage; Female; Hematologic and hematopoietic diseases; Human viral diseases; Humans; Infectious diseases; Kaplan-Meier Estimate; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Lymphoma, AIDS-Related - drug therapy; Lymphoma, AIDS-Related - mortality; Lymphoma, AIDS-Related - pathology; Male; Medical sciences; Methotrexate - administration & dosage; Middle Aged; Neoplasm Staging; Prednisone - administration & dosage; Prognosis; Prospective Studies; Treatment Outcome; Vincristine - administration & dosage; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Antineoplastic agent; Human; Immunopathology; Prognosis; Hematology; Burkitt lymphoma; Intensification; AIDS; B cell neoplasm; Malignant hemopathy; Non Hodgkin lymphoma; Immune deficiency; Infection; Prospective; Chemotherapy; Treatment; Lymphoproliferative syndrome; Viral disease; Complication; Advanced stage; L3 acute lymphocytic leukemia; Therapeutic protocol; Cancer
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood-2006-10-051771

Prognosis of acquired immunodeficiency syndrome (AIDS)–related non-Hodgkin lymphoma has improved since the introduction of highly active antiretroviral therapy. Burkitt lymphomas (BLs) still have poor outcome in patients with bone marrow (BM) or central nervous system (CNS) involvement when treated with standard-dose chemotherapy. We have prospectively evaluated the LMB86 regimen in 63 human immunodeficiency virus (HIV)–infected patients with stage IV (BM and/or CNS involvement) BL consecutively recruited between November 1992 and January 2006. At BL diagnosis, the median CD4 cell count was 239 × 106/L (range, 16-1188 × 106/L). BM and CNS involvement were present in 55 (80%) and 48 (76%) patients, respectively. Forty-four patients (70%) achieved complete response. Seven treatment-related deaths occurred and all patients experienced severe BM toxicity. With a median follow-up of 66 months (range, 6-165 months), 11 patients relapsed. The estimate 2-year overall survival and disease-free survival were 47.1% (95% CI, 34-59.1) and 67.8% (95% CI, 51-80), respectively. We identified 2 poor prognosis factors: low CD4 count and ECOG more than 2. Patients with 0 or 1 factor had good outcome (2-year survival: 60%) contrasting with patients with 2 factors (2-year survival: 12%). We conclude that LMB86 regimen is highly effective in advanced HIV-related BL and should be proposed for patients with CD4 count higher than 200 × 106/L or ECOG of 2 or less.