Excellent real-world outcomes of adults with Burkitt lymphoma treated with CODOX-M/IVAC plus or minus rituximab.

Autor: Zhu KY; Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada., Song KW; Hematology, Leukemia/BMT Program of BC, BC Cancer, University of British Columbia, Vancouver, BC, Canada., Connors JM; Centre for Lymphoid Cancer, BC Cancer, Vancouver, BC, Canada., Leitch H; Division of Hematology, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada., Barnett MJ; Hematology, Leukemia/BMT Program of BC, BC Cancer, University of British Columbia, Vancouver, BC, Canada., Ramadan K; Division of Hematology, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada., Slack GW; Department of Pathology and Laboratory Medicine, BC Cancer, University of British Columbia, Vancouver, BC, Canada., Abou Mourad Y; Hematology, Leukemia/BMT Program of BC, BC Cancer, University of British Columbia, Vancouver, BC, Canada., Forrest DL; Hematology, Leukemia/BMT Program of BC, BC Cancer, University of British Columbia, Vancouver, BC, Canada., Hogge DE; Hematology, Leukemia/BMT Program of BC, BC Cancer, University of British Columbia, Vancouver, BC, Canada., Nantel SH; Hematology, Leukemia/BMT Program of BC, BC Cancer, University of British Columbia, Vancouver, BC, Canada., Narayanan S; Hematology, Leukemia/BMT Program of BC, BC Cancer, University of British Columbia, Vancouver, BC, Canada., Nevill TJ; Hematology, Leukemia/BMT Program of BC, BC Cancer, University of British Columbia, Vancouver, BC, Canada., Power MM; Hematology, Leukemia/BMT Program of BC, BC Cancer, University of British Columbia, Vancouver, BC, Canada., Sanford DS; Hematology, Leukemia/BMT Program of BC, BC Cancer, University of British Columbia, Vancouver, BC, Canada., Sutherland HJ; Hematology, Leukemia/BMT Program of BC, BC Cancer, University of British Columbia, Vancouver, BC, Canada., Tucker T; Genetics Laboratory, BC Cancer, University of British Columbia, Vancouver, BC, Canada., Toze CL; Hematology, Leukemia/BMT Program of BC, BC Cancer, University of British Columbia, Vancouver, BC, Canada., Sehn LH; Centre for Lymphoid Cancer, BC Cancer, Vancouver, BC, Canada., Broady R; Hematology, Leukemia/BMT Program of BC, BC Cancer, University of British Columbia, Vancouver, BC, Canada., Gerrie AS; Hematology, Leukemia/BMT Program of BC, BC Cancer, University of British Columbia, Vancouver, BC, Canada.; Centre for Lymphoid Cancer, BC Cancer, Vancouver, BC, Canada.
Jazyk: angličtina
Zdroj: British journal of haematology [Br J Haematol] 2018 Jun; Vol. 181 (6), pp. 782-790. Date of Electronic Publication: 2018 May 09.
DOI: 10.1111/bjh.15262
Abstrakt: Treatment of Burkitt lymphoma (BL) with intensive, multi-agent chemotherapy with aggressive central nervous system (CNS) prophylaxis results in high cure rates, although no regimen is standard of care. We examined population-based survival outcomes of adults with BL treated with a modified combination of cyclophosphamide, vincristine, doxorubicin, prednisone and systemic high-dose methotrexate (MTX) (CODOX-M) with IVAC (ifosfamide, mesna, etoposide, cytarabine and intrathecal MTX) (CODOX-M/IVAC) ± rituximab over a 15-year period in British Columbia. For the 81 patients identified (including 8 with CNS involvement and 18 with human immunodeficiency virus-associated BL), 5-year progression-free survival (PFS) and overall survival (OS) were 75% [95% confidence interval (CI): 63-83%] and 77% (95% CI: 66-85%), respectively, with no treatment-related deaths. Those who completed the regimen per protocol (n = 38) had significantly improved 5-year PFS 86% (P = 0·04) and OS 92% (P = 0·008), as did those under 60 years with 5-year PFS 82% (P = 0·005) and OS 86% (P = 0·002), which remained significant in multivariate analysis [PFS: hazard ratio (HR) 3·36, P = 0·018; OS HR 4·03, P = 0·012]. Incorporation of high-dose systemic methotrexate also significantly affected multivariate survival outcomes (OS HR 0·28, P = 0·025). Stem cell transplant in first remission had no effect on OS or PFS. This large, real-world analysis of BL patients treated with CODOX-M/IVAC ± rituximab demonstrates excellent survival outcomes comparable to clinical trials. These results help to serve as a benchmark when comparing curative therapies for BL patients as novel regimens are incorporated into clinical practice.
(© 2018 John Wiley & Sons Ltd.)
Databáze: MEDLINE
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