Dose-intensive chemotherapy including rituximab in Burkitt's leukemia or lymphoma regardless of human immunodeficiency virus infection status: final results of a phase 2 study (Burkimab).
BACKGROUND
The use of rituximab together with intensive chemotherapy in Burkitt's lymphoma or leukemia (BL) has been scarcely explored. This study prospectively evaluated and compared the outcome and toxicity of human immunodeficiency virus (HIV)-positive and HIV-negative patients with BL who were treated in an intensive immunochemotherapy-based and age-adapted trial.


METHODS
A total of 118 adult patients (80 HIV-negative and 38 HIV-positive) aged 15 to 83 years were treated with 4 (nonbulky stages I-II) or 6 (stages II bulky, III-IV) cycles of intensive chemotherapy combined with rituximab. Reduction in chemotherapy doses and modification of the cycle schedules was performed in patients older than 55 years.


RESULTS
The clinical characteristics of HIV-positive patients were comparable with those who were HIV-negative. Complete remission rates were 82% and 87%, respectively, and 9 patients died in induction, 9 died in remission, and 7 relapsed. After a median follow-up of 2.5 years, nonsignificant differences were observed in the 4-year disease-free survival and overall survival (OS) probabilities (77% and 63% for HIV-positive and 80% and 78% for HIV-negative patients, respectively). Young HIV-infected patients presented higher incidences of grade 3 or 4 mucositis and severe infectious episodes. Poor general status and bone marrow involvement, but not advanced age, were associated with a shorter OS, allowing the definition of 3 prognostic groups, with the OS ranging from 50% to 92%.


CONCLUSIONS
Age-adapted intensive immunochemotherapy is highly effective in both HIV-negative and HIV-positive patients, with a higher toxicity in the latter group. Poor general status and bone marrow involvement had a negative impact on survival.
Hematology Department, Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Jose Carreras Leukemia Research Institute, Badalona, Spain. jribera@iconcologia.net
Josep-Maria
JM
Ribera
Olga
O
García
Carlos
C
Grande
Jordi
J
Esteve
Albert
A
Oriol
Juan
J
Bergua
José
J
González-Campos
Ferran
F
Vall-Llovera
Mar
M
Tormo
Jesús-Maria
JM
Hernández-Rivas
Daniel
D
García
Salut
S
Brunet
Natalia
N
Alonso
Pere
P
Barba
Pilar
P
Miralles
Andreu
A
Llorente
Pau
P
Montesinos
Maria-José
MJ
Moreno
Jose-Ángel
JÁ
Hernández-Rivas
Teresa
T
Bernal
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D002051:Burkitt Lymphoma / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000069283:Rituximab; D055815:Young Adult
D058846:Antibodies, Monoclonal, Murine-Derived; D000069283:Rituximab