title: Improved efficacy using rituximab and brief duration, high intensity chemotherapy with filgrastim support for Burkitt or aggressive lymphomas: cancer and Leukemia Group B study 10 002.
abstract: To improve long-term outcomes for Burkitt leukaemia/lymphoma (BL) or aggressive lymphomas in adults, we assessed the benefit of adding rituximab and filgrastim support to a dose-dense modified chemotherapy regimen from the Cancer and Leukemia Group B (CALGB) 9251 trial. One hundred and five patients (aged 19-79 years) were enrolled; 27% were >60 years old; 47% had high or high-intermediate risk by International Prognostic Index (IPI) criteria. Common severe toxicities included stomatitis/upper gastrointestinal toxicity (69%), renal insufficiency (10%), neurological events (25%) and pulmonary events (18%). Seven died from treatment-related causes (one central nervous system bleed, four infections, two respiratory failure); five were >60 years old. Results in this adult population are encouraging as complete response (CR) was observed in 83% and 4-year event-free (EFS) and overall survivals (OS) were 74% and 78%, respectively. Results compare favourably to our prior chemotherapy alone study (CALGB 9251) but despite this, high-risk patients still had worse outcomes. In conclusion, short duration, intensive chemo-immunotherapy is feasible and should be considered in adults with BL as it results in high remission rates and durable remissions.
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, NC, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Rizzieri
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Johnson
authors.forename: John C
authors.initials: JC
authors.lastname: Byrd
authors.forename: Gerard
authors.initials: G
authors.lastname: Lozanski
authors.forename: Kristie A
authors.initials: KA
authors.lastname: Blum
authors.forename: Bayard L
authors.initials: BL
authors.lastname: Powell
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Shea
authors.forename: Sreenivasa
authors.initials: S
authors.lastname: Nattam
authors.forename: Eva
authors.initials: E
authors.lastname: Hoke
authors.forename: Bruce D
authors.initials: BD
authors.lastname: Cheson
authors.forename: Richard A
authors.initials: RA
authors.lastname: Larson
mesh_terms: D000328:Adult; D000368:Aged; 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* / Q000401:mortality / Q000473:pathology; D005260:Female; D000069585:Filgrastim; D005500:Follow-Up Studies; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage; D006801:Humans; D008223:Lymphoma / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011994:Recombinant Proteins / Q000008:administration & dosage; D000069283:Rituximab; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D011994:Recombinant Proteins; D016179:Granulocyte Colony-Stimulating Factor; D000069283:Rituximab; D000069585:Filgrastim
keywords: Burkitt leukaemia; Burkitt lymphoma; chemo-immunotherapy; rituximab