Risk-adapted dose-adjusted etoposide, doxorubicin, cyclophosphamide, vincristine, prednisone, and rituximab (DA-EPOCH-R) therapy is effective and well tolerated in adults with Burkitt lymphoma regardless of age or HIV status, according to a recent study.
Burkitt lymphoma is considered curable with dose-intensive chemotherapy derived from pediatric leukemia regimens. However, this treatment is acutely toxic with late sequelae.
Wyndham H Wilson, MD, PhD, Lymphoid Malignancies Branch, National Cancer Institute (Bethesda, MA), and colleagues designed a study to determine if DA-EPOCH-R can mitigate the need for highly dose-intensive chemotherapy in adults with Burkitt lymphoma. The risk-adapted study assessed 113 patients across 22 centers with untreated disease. Eighty-seven percent (n = 98) of patients had high-risk disease. Bone marrow or CSF was involved in 26% of patients, and 25% were HIV-positive.
Researchers administered three cycles without CNS prophylaxis to low-risk patients, and six cycles with intrathecal CNS prophylaxis or extended intrathecal treatment if leptomeninges were involved to high-risk patients. The primary endpoint of the study was event-free survival (EFS), and secondary endpoints included toxicity as well as predictors of EFS and overall survival (OS).
Results of the analysis were published in the Journal of Clinical Oncology (online May 26, 2020; doi:10.1200/JCO.20.00303).
At a median follow-up of 58.7 months, EFS and OS were 84.5% and 87.0%, respectively. Researchers also noted that EFS was 100% and 82.1% in low- and high-risk patients, respectively.
Therapy was equally effective across age groups, HIV status, and International Prognostic Index risk groups, they added.
Furthermore, Dr Wilson and colleagues found that involvement of the CSF identified the patients at the greatest risk for early toxicity-related death or treatment failure. Febrile neutropenia occurred in 16% of cycles, and tumor lysis syndrome was rare.
“With this finding, we not only have a potentially curative treatment option for these patients that is less toxic, but one that appears effective for most adults, including older patients and those with HIV and other comorbidities who might not be able to receive standard treatment,” said co-author Mark Roschewski, MD, National Cancer Institute, in a press release (May 26, 2020).—Zachary Bessette
