Overview of Burkitt's Lymphoma
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Burkitt are highly
aggressive lymphomas. As such, the goal of treatment
is usually to cure the disease with aggressive
therapy.
From OncologyChannel: "Small noncleaved cell lymphoma (SNCL) is a classification that, in general, has been replaced by the terms
Burkitt lymphoma and Burkitt-like (or non-Burkitt) lymphoma.
In children, most SNCLs are
Burkitt lymphomas, whereas most adult SNCLs are Burkitt-like lymphomas.
Burkitt's lymphoma tends to occur most often in children and in adults with compromised immune systems.
There are three distinct forms of this disease: endemic, sporadic, and immunodeficient.
Endemic Burkitt lymphoma is seen among the young of equatorial Africa. It frequently affects the jaws of children with developing molar teeth; experts suggest that growth factors may be responsible for the site-specific nature of this tumor.
Sporadic Burkitt lymphoma often involves the abdomen, and it spreads to the bone marrow in about 20% of patients.
Immunodeficient
Burkitt lymphoma affects patients with abnormal immune systems (e.g., patients with HIV)."
Source:
oncologychannel.com
Resources
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Treatments
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see:
Questions for your doctor - Patients
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See
NCCN.org guidelines, page 57
for combination protocols used with curative intent, such as:
CALGB 9251 or CODOX-M, or HyperCVAD or dose-adjusted EPOCH
Protocols may be adjusted based on high or low risk disease.
(free registration required) |
NCCN.org notes that CHOP-R is not
adequate.
We copy one overview of therapy from a clinical
trial:
Detailed Description:
Patients will be placed into one of two groups, "low risk" and "high
risk". "Low risk" disease is defined as one area of disease measuring
less than 10cm and a normal blood test called LDH (lactate hydrogenase).
Patients not fitting the "low risk" criteria are considered "high risk".
If the patient has "low risk" disease their treatment cycle consist of
three cycles of A.
If the patient has "high risk" disease they will receive Cycle A
followed by cycle B which will then repeat.
Cycle A consists of the drugs: rituximab, cyclophosphamide, oncovin,
doxorubicin and methotrexate (R-CODOX-M). The treatment cycle is
approximately 14 days. A spinal tap is performed on day 1 and day 3 of
the cycle and the patient will be hospitalized until between day 11 and
day 13. After the patient's blood counts return to normal(usually around
day 21),the next round of treatment will occur.
Cycle B consists of the drugs: rituximab, ifosfamide, VP-16 and ara-c (IVAC).
The treatment cycle is approximately 5 days. A spinal tap is performed
on day 4 and once blood counts return to normal the patient will start
cycle A again.
* After the patient has finished the treatments, they will be
re-evaluated with CT scans and PET scans to determine whether or not
they are in remission. Every three months for two years, blood tests and
CT and PET scans will be performed. Follow up after that will be every 6
months for two years.
http://clinicaltrials.gov/ct2/show/NCT00126191
Related Resources
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Treatment of Burkitt's/Burkitt-like lymphoma in adolescents
and adults: a 20-year experience from the Norwegian Radium
Hospital with the use of three successive regimens http://annonc.oxfordjournals.org
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ASH: Chemotherapy Regimen Induces Complete Remissions in Burkitt's
By Neil Osterweil, Senior Associate Editor, MedPage Today
Published: December 11, 2006 .medpagetoday.com
A novel approach to Burkitt's lymphoma, using a regimen designed for large B-cell lymphomas, led to complete remissions in all patients in a small study, investigators reported here.
In a study of 19 patients with Burkitt's, the highly aggressive B-cell lymphoma, all 19 treated with
dose-adjusted EPOCH with Rituxan (rituximab) had a complete remission, with few of the adverse events associated with standard chemotherapy for Burkitt's lymphoma, reported Kieron Dunleavy, M.D., of the National Cancer Institute in Bethesda, Md., and colleagues.
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An international evaluation of CODOX-M and
CODOX-M alternating with IVAC in adult Burkitt's lymphoma: results
of United Kingdom Lymphoma Group LY06 study.
Ann Oncol. 2002 Aug;13(8):1264-74. PMID:
12181251
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Burkitt lymphoma in adults: a prospective study
of 72 patients treated with an adapted pediatric LMB protocol. Ann
Oncol. 2005 Dec;16(12):1928-35. Epub 2005 Nov 10.
PMID:
16284057 | Related
articles
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Sequential doxorubicin and topotecan in
relapsed/refractory aggressive Burkitt's / DLBCL: Results of CALGB
59906. Leuk Lymphoma. 2006 Aug;47(8):1511-7. PMID:
16966261
Five (of 26) patients (20%, 95% confidence interval
0.07, 0.42) responded with two (8%) complete remissions and three
(12%) partial remissions; an additional four (16%) patients had
stable disease. Both patients achieving a complete remission had
Burkitt's lymphoma. There were no treatment-related deaths. In
conclusion, the combination of doxorubicin and topotecan is well
tolerated and has modest activity in relapsed/refractory NHL, with
occasional patients having a prolonged remission. The activity in
Burkitt's lymphoma should be investigated further.
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