Multicenter Study of Risk-Adapted Therapy With Dose-Adjusted EPOCH-R in Adults With Untreated Burkitt Lymphoma

被引:112
作者
Roschewski, Mark [1 ]
Dunleavy, Kieron [2 ]
Abramson, Jeremy S. [3 ]
Powell, Bayard L. [4 ]
Link, Brian K. [5 ]
Patel, Prapti [6 ]
Bierman, Philip J. [7 ]
Jagadeesh, Deepa [8 ]
Mitsuyasu, Ronald T. [9 ]
Peace, David [10 ]
Watson, Peter R. [11 ]
Hanna, Wahid T. [13 ]
Melani, Christopher [1 ]
Lucas, Andrea N. [1 ]
Steinberg, Seth M. [14 ]
Pittaluga, Stefania [15 ]
Jaffe, Elaine S. [15 ]
Friedberg, Jonathan W. [12 ,16 ]
Kahl, Brad S. [17 ]
Little, Richard F. [18 ]
Bartlett, Nancy L. [17 ]
Fanale, Michelle A. [19 ,20 ]
Noy, Ariela [21 ,22 ]
Wilson, Wyndham H. [1 ]
机构
[1] NCI, Lymphoid Malignancies Branch, Bethesda, MD 20892 USA
[2] George Washington Univ, Canc Ctr, Washington, DC USA
[3] Massachusetts Gen Hosp, Canc Ctr, Boston, MA 02114 USA
[4] Wake Forest Baptist Hlth, Comprehens Canc Ctr, Winston Salem, NC USA
[5] Univ Iowa Hosp & Clin, Iowa City, IA 52242 USA
[6] Univ Texas Southwestern, Dallas, TX USA
[7] Univ Nebraska Med Ctr, Omaha, NE USA
[8] Cleveland Clin, Taussig Canc Inst, Cleveland, OH 44106 USA
[9] Univ Calif Los Angeles, Clin AIDS Res & Educ Ctr, Los Angeles, CA USA
[10] Univ Illinois, Chicago, IL USA
[11] Kinston Med Specialists, Kinston, NC USA
[12] Montefiore Med Ctr, 111 E 210th St, Bronx, NY 10467 USA
[13] Univ Tennessee, Med Ctr, Knoxville, TN USA
[14] NCI, Biostat & Data Management Sect, Ctr Canc Res, Bethesda, MD 20892 USA
[15] NCI, Hematopathol Sect, Lab Pathol, Ctr Canc Res, Bethesda, MD USA
[16] Univ Rochester, Wilmot Canc Inst, Rochester, NY USA
[17] Washington Univ, Sch Med, St Louis, MO USA
[18] NCI, Div Canc Therapy & Diag, Bethesda, MD 20892 USA
[19] Univ Texas MD Anderson Canc Ctr, Houston, TX 77030 USA
[20] Seattle Genet, Seattle, WA USA
[21] Mem Sloan Kettering Canc Ctr, 1275 York Ave, New York, NY 10021 USA
[22] Weill Cornell Med Coll, New York, NY USA
基金
美国国家卫生研究院;
关键词
NON-HODGKINS-LYMPHOMA; ACUTE-LYMPHOBLASTIC-LEUKEMIA; B-CELL LYMPHOMAS; CODOX-M/IVAC; MULTIAGENT CHEMOTHERAPY; PHASE-II; RITUXIMAB; CHILDREN; ADOLESCENTS; CANCER;
D O I
10.1200/JCO.20.00303
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
PURPOSEBurkitt lymphoma is an aggressive B-cell lymphoma curable with dose-intensive chemotherapy derived from pediatric leukemia regimens. Treatment is acutely toxic with late sequelae. We hypothesized that dose-adjusted etoposide, doxorubicin, cyclophosphamide, vincristine, prednisone, and rituximab (DA-EPOCH-R) may obviate the need for highly dose-intensive chemotherapy in adults with Burkitt lymphoma.METHODSWe conducted a multicenter risk-adapted study of DA-EPOCH-R in untreated adult Burkitt lymphoma. Low-risk patients received three cycles without CNS prophylaxis, and high-risk patients received six cycles with intrathecal CNS prophylaxis or extended intrathecal treatment if leptomeninges were involved. The primary endpoint was event-free survival (EFS), and secondary endpoints were toxicity and predictors of EFS and overall survival (OS).RESULTSBetween 2010 and 2017, 113 patients were enrolled across 22 centers, and 98 (87%) were high risk. The median age was 49 (range, 18-86) years, and 62% were >= 40 years. Bone marrow and/or CSF was involved in 29 (26%) of patients, and 28 (25%) were HIV positive. At a median follow-up of 58.7 months, EFS and OS were 84.5% and 87.0%, respectively, and EFS was 100% and 82.1% in low- and high-risk patients. Therapy was equally effective across age groups, HIV status, and International Prognostic Index risk groups. Involvement of the CSF identified the group at greatest risk for early toxicity-related death or treatment failure. Five treatment-related deaths (4%) occurred during therapy. Febrile neutropenia occurred in 16% of cycles, and tumor lysis syndrome was rare.CONCLUSIONRisk-adapted DA-EPOCH-R therapy is effective in adult Burkitt lymphoma regardless of age or HIV status and was well tolerated. Improved therapeutic strategies for adults with CSF involvement are needed (funded by the National Cancer Institute; ClinicalTrials.gov identifier: NCT01092182).
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收藏
页码:2519 / +
页数:12
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