Improved efficacy using rituximab and brief duration, high intensity chemotherapy with filgrastim support for Burkitt or aggressive lymphomas: cancer and Leukemia Group B study 10 002

• Published in: British journal of haematology 2014-04, Vol.165 (1), p.102-111
• Main Authors: Rizzieri, David A., Johnson, Jeffrey L., Byrd, John C., Lozanski, Gerard, Blum, Kristie A., Powell, Bayard L., Shea, Thomas C., Nattam, Sreenivasa, Hoke, Eva, Cheson, Bruce D., Larson, Richard A.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Antibodies, Monoclonal, Murine-Derived - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Burkitt leukaemia; Burkitt lymphoma; Burkitt Lymphoma - drug therapy; Burkitt Lymphoma - mortality; Burkitt Lymphoma - pathology; chemo‐immunotherapy; Female; Filgrastim; Follow-Up Studies; Granulocyte Colony-Stimulating Factor - administration & dosage; Hematologic and hematopoietic diseases; Humans; Infectious diseases; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Lymphoma - drug therapy; Lymphoma - mortality; Lymphoma - pathology; Male; Medical sciences; Middle Aged; Multiple tumors. Solid tumors. Tumors in childhood (general aspects); Neoplasm Staging; Recombinant Proteins - administration & dosage; Rituximab; Treatment Outcome; Tumors; Viral diseases; Young Adult
• ISSN: 0007-1048; 1365-2141
• DOI: 10.1111/bjh.12736

Summary To improve long‐term outcomes for Burkitt leukaemia/lymphoma (BL) or aggressive lymphomas in adults, we assessed the benefit of adding rituximab and filgrastim support to a dose‐dense modified chemotherapy regimen from the Cancer and Leukemia Group B (CALGB) 9251 trial. One hundred and five patients (aged 19–79 years) were enrolled; 27% were >60 years old; 47% had high or high‐intermediate risk by International Prognostic Index (IPI) criteria. Common severe toxicities included stomatitis/upper gastrointestinal toxicity (69%), renal insufficiency (10%), neurological events (25%) and pulmonary events (18%). Seven died from treatment‐related causes (one central nervous system bleed, four infections, two respiratory failure); five were >60 years old. Results in this adult population are encouraging as complete response (CR) was observed in 83% and 4‐year event‐free (EFS) and overall survivals (OS) were 74% and 78%, respectively. Results compare favourably to our prior chemotherapy alone study (CALGB 9251) but despite this, high‐risk patients still had worse outcomes. In conclusion, short duration, intensive chemo‐immunotherapy is feasible and should be considered in adults with BL as it results in high remission rates and durable remissions.