Update of the M. D. Anderson Cancer Center experience with hyper-CVAD and rituximab for the treatment of mantle cell and Burkitt-type lymphomas.
Mantle cell lymphoma (MCL) and Burkitt lymphoma respond to initial intense therapies, such as hyper-CVAD (hyperfractionated cyclophosphamide/vincristine/doxorubicin/dexamethasone) alternating with high-dose methotrexate/cytarabine, to which the monoclonal antibody rituximab has recently been added. This report provides an update detailing the long-term outcome when this chemoimmunotherapy regimen is used as first-line therapy for newly diagnosed MCL, de novo Burkitt lymphoma, atypical Burkitt lymphoma, and mature B-cell acute lymphoblastic lymphoma (B-ALL). Ninety-seven patients with de novo MCL and 31 patients with Burkitt lymphoma, atypical Burkitt lymphoma, and B-ALL were treated with rituximab plus hyper-CVAD alternating with rituximab/methotrexate/cytarabine under different institutional trials approved by the University of Texas M. D. Anderson Cancer Center Institutional Review Board. Overall response rate (RR) for patients with MCL was 97% (complete response [CR]/unconfirmed CR rate, 87%). At a median follow-up of 4.8 months, the 5-year failure-free survival and OS rates were 48% and 65%, respectively. Among patients aged < or = 65 years, the 5 year failure-free survival was 60%. Patients with blastoid morphology have a 7-year survival rate of 47%. Toxicity was mainly hematologic but significant. Overall RR for patients with Burkitt lymphoma/atypical Burkitt lymphoma/B-ALL was 97% (CR rate, 86%). With a median follow-up of 22 months, the estimated 3-year OS, disease-free survival, and event-free survival rates were 89%, 88%, and 80%, respectively. Rituximab plus hyper-CVAD alternating with rituximab/methotrexate/cytarabine is an effective dose-intense chemoimmunotherapy program for untreated MCL, Burkitt lymphoma, atypical Burkitt lymphoma, and B-ALL. Toxicity is mainly hematologic and significant, but expected.
Fayad
Luis
L
Department of Lymphoma and Myeloma, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA. lefayad@mdanderson.org
Thomas
Deborah
D
Romaguera
Jorge
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002051:Burkitt Lymphoma / Q000188:drug therapy* / Q000473:pathology; D003520:Cyclophosphamide / Q000627:therapeutic use; D003907:Dexamethasone / Q000627:therapeutic use; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D020522:Lymphoma, Mantle-Cell / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D000069283:Rituximab; D015996:Survival Rate; D013781:Texas; D016896:Treatment Outcome; D014750:Vincristine / Q000627:therapeutic use
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; D000069283:Rituximab; D014750:Vincristine; D003907:Dexamethasone; D004317:Doxorubicin; D003520:Cyclophosphamide