Journal article
Multicenter Study of Risk-Adapted Therapy With Dose-Adjusted EPOCH-R in Adults With Untreated Burkitt Lymphoma
Journal of clinical oncology, Vol.38(22), pp.2519-2529
08/01/2020
DOI: 10.1200/JCO.20.00303
PMCID: PMC7392744
PMID: 32453640
Abstract
Burkitt 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.
We 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).
Between 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.
Risk-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).
Details
- Title: Subtitle
- Multicenter Study of Risk-Adapted Therapy With Dose-Adjusted EPOCH-R in Adults With Untreated Burkitt Lymphoma
- Creators
- Mark Roschewski - National Cancer InstituteKieron Dunleavy - George Washington UniversityJeremy S Abramson - Massachusetts General HospitalBayard L Powell - Atrium Health Wake Forest BaptistBrian K Link - University of IowaPrapti Patel - The University of Texas Southwestern Medical CenterPhilip J Bierman - University of Nebraska Medical CenterDeepa Jagadeesh - Cleveland ClinicRonald T Mitsuyasu - University of California Los Angeles Clinical AIDS Research and Education Center, Los Angeles, CA.David Peace - University of Illinois at ChicagoPeter R Watson - Kinston Medical SpecialistsWahid T Hanna - University of Tennessee Medical CenterChristopher Melani - National Cancer InstituteAndrea N Lucas - National Cancer InstituteSeth M Steinberg - National Cancer InstituteStefania Pittaluga - Hematopathology Section, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, MD.Elaine S Jaffe - Hematopathology Section, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, MD.Jonathan W Friedberg - Montefiore Medical CenterBrad S Kahl - Washington University in St. LouisRichard F Little - National Cancer InstituteNancy L Bartlett - Washington University in St. LouisMichelle A Fanale - MD Anderson Cancer Center, Houston, TX, and Seattle Genetics, Seattle, WA.Ariela Noy - Memorial Sloan Kettering Cancer CenterWyndham H Wilson - National Cancer Institute
- Resource Type
- Journal article
- Publication Details
- Journal of clinical oncology, Vol.38(22), pp.2519-2529
- DOI
- 10.1200/JCO.20.00303
- PMID
- 32453640
- PMCID
- PMC7392744
- ISSN
- 0732-183X
- eISSN
- 1527-7755
- Grant note
- Z99 CA999999 / Intramural NIH HHS U01 CA121947 / NCI NIH HHS U10 CA180888 / NCI NIH HHS UG1 CA233230 / NCI NIH HHS
- Language
- English
- Date published
- 08/01/2020
- Academic Unit
- Hematology, Oncology, and Blood & Marrow Transplantation; Internal Medicine
- Record Identifier
- 9984359830302771
Metrics
9 Record Views