title: RD-CODOX-M/IVAC with rituximab and intrathecal liposomal cytarabine in adult Burkitt lymphoma and 'unclassifiable' highly aggressive B-cell lymphoma.
abstract: Specific trials on adult Burkitt lymphoma (BL) and 'unclassifiable' lymphomas with features intermediate between BL and diffuse large B-cell lymphoma (BL/DLBCL) are advocated which include substantial numbers of older patients, to improve treatment feasibility, while countering risks of systemic and central nervous system (CNS) recurrences. We prospectively evaluated a modified CODOX-M/IVAC (CODOX-M: cyclophosphamide, vincristine, doxorubicin, high-dose methotrexate; IVAC: ifosfamide, etoposide and high-dose cytarabine) regimen by the addition of rituximab (R) and liposome-encapsulated cytarabine (D) to increase antitumour activity and halve the number of intrathecal treatments. Thirty adults (40% >60years) with BL (n=15) and BL/DLBCL (n=15) were accrued. Primary endpoints were progression-free survival (PFS), CNS recurrence, and liposomal cytarabine-associated toxicity. Eighty percent of patients received the whole treatment programme, the remaining cases received at least three full courses. Application of the RD-CODOX-M/IVAC regimen resulted in remarkable 4-year PFS (78%) and complete remission (CR) rates (93%). However, PFS was significantly lower in patients older than 60years as compared to younger ones (49%vs 93%, P=0·03; median, 36months), despite high actual dose-intensity, CR rate and tolerability. Reduced-intensity intratechal prophylaxis through liposomal cytarabine was effective because the CNS failure rate was low (3·4%) and without severe neurological toxicities. The RD-CODOX-M/IVAC strategy is feasible and highly effective, but improving outcomes in elderly patients remains a priority.
authors.affiliation: Haematology-Oncology and Stem Cell Transplantation Unit, Fondazione 'G. Pascale,' IRCCS, Naples, Italy. g.corazzelli@istitutotumori.na.it
authors.forename: Gaetano
authors.initials: G
authors.lastname: Corazzelli
authors.forename: Ferdinando
authors.initials: F
authors.lastname: Frigeri
authors.forename: Filippo
authors.initials: F
authors.lastname: Russo
authors.forename: Chiara
authors.initials: C
authors.lastname: Frairia
authors.forename: Manuela
authors.initials: M
authors.lastname: Arcamone
authors.forename: Gennaro
authors.initials: G
authors.lastname: Esposito
authors.forename: Annarosaria
authors.initials: A
authors.lastname: De Chiara
authors.forename: Emanuela
authors.initials: E
authors.lastname: Morelli
authors.forename: Gaetana
authors.initials: G
authors.lastname: Capobianco
authors.forename: Cristina
authors.initials: C
authors.lastname: Becchimanzi
authors.forename: Francesco
authors.initials: F
authors.lastname: Volzone
authors.forename: Mariangela
authors.initials: M
authors.lastname: Saggese
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Marcacci
authors.forename: Rosaria
authors.initials: R
authors.lastname: De Filippi
authors.forename: Umberto
authors.initials: U
authors.lastname: Vitolo
authors.forename: Antonio
authors.initials: A
authors.lastname: Pinto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects; D002051:Burkitt Lymphoma / Q000188:drug therapy* / Q000473:pathology; D003561:Cytarabine / Q000008:administration & dosage / Q000009:adverse effects; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007278:Injections, Spinal; D008081:Liposomes / Q000008:administration & dosage; D016393:Lymphoma, B-Cell / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D000069283:Rituximab
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D008081:Liposomes; D003561:Cytarabine; D000069283:Rituximab