Chemoimmunotherapy with hyper-CVAD plus rituximab for the treatment of adult Burkitt and Burkitt-type lymphoma or acute lymphoblastic leukemia
Deborah A Thomas, Stefan Faderl, Susan O'Brien, Carlos Bueso-Ramos, Jorge Cortes, Guillermo Garcia-Manero, Francis J Giles, Srdan Verstovsek, William G Wierda, Sherry A Pierce, Jianqin Shan, Mark Brandt, Fredrick B Hagemeister, Michael J Keating, Fernando Cabanillas, Hagop Kantarjian, Deborah A Thomas, Stefan Faderl, Susan O'Brien, Carlos Bueso-Ramos, Jorge Cortes, Guillermo Garcia-Manero, Francis J Giles, Srdan Verstovsek, William G Wierda, Sherry A Pierce, Jianqin Shan, Mark Brandt, Fredrick B Hagemeister, Michael J Keating, Fernando Cabanillas, Hagop Kantarjian
Abstract
Background: Adult Burkitt-type lymphoma (BL) and acute lymphoblastic leukemia (B-ALL) are rare entities composing 1% to 5% of non-Hodgkin lymphomas NHL) or ALL. Prognosis of BL and B-ALL has been poor with conventional NHL or ALL regimens, but has improved with dose-intensive regimens.
Methods: To evaluate the addition of rituximab, a CD20 monoclonal antibody, to intensive chemotherapy in adults with BL or B-ALL, 31 patients with newly diagnosed BL or B-ALL received the hyper-fractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone (hyper-CVAD) regimen with rituximab. Their median age was 46 years; 29% were 60 years or older. Rituximab 375 mg/m(2) was given on Days 1 and 11 of hyper-CVAD courses and on Days 1 and 8 of methotrexate and cytarabine courses.
Results: Complete remission (complete response [CR]) was achieved in 24 of 28 (86%) evaluable patients; 3 had a partial response, and 1 had resistant disease. There were no induction deaths. The 3-year overall survival (OS), event-free survival, and disease-free survival rates were 89%, 80%, and 88%, respectively. Nine elderly patients achieved CR with all of them in continuous CR (except 1 death in CR from infection), with a 3-year OS rate of 89%. Multivariate analysis of current and historical (those treated with hyper-CVAD alone) groups identified age and treatment with rituximab as favorable factors.
Conclusions: The addition of rituximab to hyper-CVAD may improve outcome in adult BL or B-ALL, particularly in elderly patients.
Copyright 2006 American Cancer Society.
Source: PubMed