Important note: Information in this article was accurate in 1993. The state of the art may have changed since the publication date.
Results of treatment of Burkitt's lymphoma in non-HIV+ patients (Meeting abstract).
Lymphoma: the next questions. April 2-4, 1992, Orlando, FL, 1992.. Unique Identifier : AIDSLINE ICDB/93690617 Hagemeister FB; Dept. of Hematology, MD Anderson Cancer Center, Houston, TX
Abstract:
Although SNCCL is one of the more common lymphoma subtypes in children, in both Africa and the United States, it is rare in adults. Although it responds dramatically to chemotherapy in both children and adults, it is considered a high-grade lymphoma in the International Working Formulation, and carries a much less favorable prognosis than does large cell lymphoma, the more common disease with which it is often grouped in treatment reports. From 1960 to 1980, we treated 33 adults with CHOP- or COP-based regimens; although the CR rate was 55%, the 5-yr survival result was only 29%. In order to improve results with this disease, in 1981 we developed the 'MCOP' regimen, which included 2 cycles of MCOP (methotrexate, cyclophosphamide, vincristine, prednisone) followed by 2 cycles of IMVP16 (ifosfamide, methotrexate, VP16) followed by 2 cycles of HOAP-Bleo (Adriamycin, vincristine, ara-C, prednisone, bleomycin). From 1984 to 1988, this program was modified in that ara-C was added to MCOP, and cyclophosphamide was substituted for ifosfamide in IMVP16. All patients (pts) received CNS prophylaxis with methotrexate and ara-C, and all received maintenance therapy to complete 1 yr of treatment. Of the 44 pts treated, there were no significant differences in presentation between those with Burkitt's (n=16) and those with non-Burkitt's (n=23) histologies. 80% of the pts entered CR: various factors associated with a low CR rate included NCI Stage D, Ann Arbor Stage IV, marrow involvement, age over 40 yr, and serum LDH greater than 500 (n=225). By multivariate analysis, Ann Arbor Stage IV and age over 40 yr were the most important adverse prognostic factors predicting freedom from progression (FFP) results, with 5-yr results of 24% and 40%, respectively. However, only 2/7 pts with marrow disease were free of progressive disease at 5 yr. CNS and bone marrow relapse occurred in 10 pts, 9 of whom had Stage IV disease, 7 of whom had never attained CR. 12/44 pts had positive HIV serology, but CR rates and FFP results were similar for these 12 and for those with negative serologies. However, survivals for those with positive HIV were poor due to complications of AIDS occurring after completion of chemotherapy. It appears that most pts with Stages I-III SNCCL may be cured with intensive therapy, and recent studies suggest that prolonged treatment is not necessary. However, pts with Stage IV disease and those over the age of 40 may need early intensification with very-high-dose therapy in order to improve results for this subgroup.
Keywords: Adult Antineoplastic Agents, Combined/*THERAPEUTIC USE Bleomycin/ADMINISTRATION & DOSAGE Burkitt's Lymphoma/*DRUG THERAPY Cyclophosphamide/ADMINISTRATION & DOSAGE Cytarabine/ADMINISTRATION & DOSAGE Doxorubicin/ADMINISTRATION & DOSAGE Human HIV Infections Lymphoma, Small Noncleaved-Cell/DRUG THERAPY Methotrexate/ADMINISTRATION & DOSAGE Prednisone/ADMINISTRATION & DOSAGE Vincristine/ADMINISTRATION & DOSAGE ABSTRACT 930830
M9380825
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Important note: Information in this article was accurate in 1993. The state of the art may have changed since the publication date.
