Short intensive sequential therapy followed by autologous stem cell transplantation in adult Burkitt, Burkitt-like and lymphoblastic lymphoma

• Published in: Leukemia Vol. 19; no. 6; pp. 945 - 952
• Main Authors: VAN IMHOFF, G. W, VAN DER HOLT, B, RAEMAEKERS, J. M. M, SONNEVELD, P, MEULENDIJKS, L. A. M. H, KLUIN, P. M, KLUIN-NELEMANS, H. C, VERDONCK, L. F, MACKENZIE, M. A, OSSENKOPPELE, G. J, WIJERMANS, P. W, KRAMER, M. H. H, VAN 'T VEER, M. B, SCHOUTEN, H. C, VAN MARWIJK KOOY, M, VAN OERS, M. H. J
• Format: Journal Article
• Language: English
• Published: London Nature Publishing 01-06-2005; Nature Publishing Group
• Subjects: Adolescent; Adult; Adults; Antibiotics, Antineoplastic - administration & dosage; Antibiotics, Antineoplastic - adverse effects; Antineoplastic Agents, Alkylating - administration & dosage; Antineoplastic Agents, Alkylating - adverse effects; Antineoplastic Agents, Phytogenic - administration & dosage; Antineoplastic Agents, Phytogenic - adverse effects; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Autografts; Biological and medical sciences; Bone marrow; Burkitt Lymphoma - drug therapy; Burkitt Lymphoma - mortality; Burkitt's lymphoma; Central nervous system; Chemotherapy; Combined Modality Therapy; Cyclophosphamide; Cyclophosphamide - administration & dosage; Cyclophosphamide - adverse effects; Cytarabine; Doxorubicin; Doxorubicin - administration & dosage; Doxorubicin - adverse effects; Etoposide; Etoposide - administration & dosage; Etoposide - adverse effects; Female; Follow-Up Studies; Hematologic and hematopoietic diseases; Hematopoietic Stem Cell Transplantation; Humans; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Lymphoma; Male; Medical sciences; Methotrexate; Middle Aged; Mitoxantrone; Mitoxantrone - administration & dosage; Mitoxantrone - adverse effects; Patients; Precursor Cell Lymphoblastic Leukemia-Lymphoma - drug therapy; Precursor Cell Lymphoblastic Leukemia-Lymphoma - mortality; Prednisone; Prednisone - administration & dosage; Prednisone - adverse effects; Stem cell transplantation; Stem cells; Transplantation; Transplantation, Autologous; Human; Hematology; Stem cell; Burkitt lymphoma; Lymphoblastic lymphoma; autologous stem cell transplantation; Hematopoietic cell; Malignant hemopathy; Non Hodgkin lymphoma; Infection; Autograft; Treatment; Sequential; Lymphoproliferative syndrome; Viral disease; adult Burkitt lymphoma; Graft; Adult; Burkitt-like lymphoma
• ISSN: 0887-6924; 1476-5551
• DOI: 10.1038/sj.leu.2403733

The feasibility and efficacy of up-front high-dose sequential chemotherapy followed by autologous stem cell transplantation (ASCT) in previously untreated adults (median age 33 years; range 15-64) with Burkitt lymphoma (BL), Burkitt-like lymphoma (BLL) or lymphoblastic lymphoma (LyLy), both without central nervous system or extensive bone marrow involvement was investigated in a multicenter phase II study. Treatment consisted of two sequential high-dose chemotherapy induction courses incorporating prednisone, cyclophosphamide, doxorubicin, etoposide and mitoxantrone, without high-dose methotrexate or high-dose cytarabine. Patients with at least PR went on with BEAM and ASCT. Protocol treatment was completed by 23/27 (85%) BL/BLL and 13/15 (87%) LyLy patients. Median treatment duration until BEAM was 70 (range: 50-116) days. No toxic deaths occurred. Response to treatment was complete response (CR) 81% and partial response (PR) 11% for BL/BLL, CR 73% and PR 20% for LyLy. At a median follow-up of 61 months of patients still alive, six BL/BLL and eight LyLy patients have died. The actuarial 5-year overall and event-free survival estimates are 81 and 73% for BL/BLL vs 46 and 40% for LyLy patients. In conclusion, this short up-front high-dose sequential chemotherapy regimen, followed by ASCT is highly effective in adults with BL/BLL with limited bone marrow involvement, but less so in patients with LyLy.