New Burkitt's Lymphoma Regimen Effective With Reduced Toxicity

ORLANDO—Preliminary results with dose-adjusted EPOCH-rituximab (Rituxan) (DA-EPOCH-R) for Burkitt's Lymphoma suggest that the treatment is very promising and has low toxicity, according to a study presented at the 48th Annual Meeting of the American Society of Hematology (abstract 2736). The study population is small, just 19 patients, but the results so far are very encouraging, said lead author Kieron Dunleavy, MD, of the NCI's Center for Cancer Research.

Burkitt's lymphoma is a highly curable disease, but the standard treatment (intensive multiagent chemotherapy), although effective, is very toxic, particularly in older patients and patients who are HIV positive or immunosuppressed. Dr. Dunleavy and his colleagues had been using dose-adjusted EPOCH with rituximab to treat diffuse large B-cell lymphoma for a number of years, with excellent results. They proposed that the same regimen would be as effective as standard first-line treatment of Burkitt's lymphoma, with less toxicity.

The study enrolled 19 patients with untreated Burkitt's lymphoma who were mostly in their 20s (range, 18 to 66 years). More than half had advanced disease, and 65% had extranodal disease. No patients had central nervous system disease.

Patients who were HIV negative received six cycles of DA-EPOCH-R, while those with HIV-associated Burkitt's lymphoma received three to six cycles (one cycle beyond a complete response for a minimum of three cycles). All patients received intrathecal methotrexate prophylaxis; treatment was administered in the outpatient clinic whenever possible.

The DA-EPOCH-R regimen was "extremely successful," Dr. Dunleavy reported. All patients achieved a complete remission, and all tolerated the treatment very well, he said. One patient received consolidative radiotherapy to a single site of residual disease. At 28 months' follow-up, overall and progression-free survival rates are both 100%, and event-free survival is 92.3%.

Significant toxicities include fever/neutropenia and thrombocytopenia. There were no treatment-related deaths, and only one occurrence of tumor lysis syndrome. Only 10% of treatment cycles involved hospitalization for low blood counts and fever, Dr. Dunleavy said.

Senior author Wyndham H. Wilson, MD, also with the Center for Cancer Research, commented, "When these patients are not cured, they usually relapse within 1 year. The 2-year median follow-up data so far are very promising. Results are close to what we see with standard therapy, in terms of long-term outcome." Dr. Wilson predicted that DA-EPOCH-R is likely going to be a less expensive treatment than the current therapy because it is less toxic and requires less hospitalization. "This is an outpatient therapy, compared to typical regimens that often require much more time in hospital," he said.