Modified cyclophosphamide, vincristine, doxorubicin, and methotrexate (CODOX-M)/ifosfamide, etoposide, and cytarabine (IVAC) therapy with or without rituximab in Japanese adult patients with Burkitt lymphoma (BL) and B cell lymphoma, unclassifiable, with features intermediate between diffuse large B cell lymphoma and BL

• Published in: International journal of hematology 2010-12, Vol.92 (5), p.732-743
• Main Authors: Maruyama, Dai, Watanabe, Takashi, Maeshima, Akiko Miyagi, Nomoto, Junko, Taniguchi, Hirokazu, Azuma, Teruhisa, Mori, Masakazu, Munakata, Wataru, Kim, Sung-Won, Kobayashi, Yukio, Matsuno, Yoshihiro, Tobinai, Kensei
• Format: Article
• Language: English
• Subjects: Adult; Antibodies, Monoclonal, Murine-Derived - therapeutic use; Antineoplastic Agents - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Burkitt Lymphoma - drug therapy; Burkitt Lymphoma - pathology; Cyclophosphamide - administration & dosage; Cytarabine - administration & dosage; Disease-Free Survival; Doxorubicin - administration & dosage; Etoposide - administration & dosage; Female; Hematologic and hematopoietic diseases; Hematology; Humans; Ifosfamide - administration & dosage; Infectious diseases; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Lymphoma, B-Cell - drug therapy; Lymphoma, B-Cell - pathology; Male; Medical sciences; Medicine; Medicine & Public Health; Methotrexate - administration & dosage; Middle Aged; Oncology; Original Article; Rituximab; Treatment Outcome; Vincristine - administration & dosage; Viral diseases; Young Adult
• ISSN: 0925-5710; 1865-3774
• DOI: 10.1007/s12185-010-0728-0

The feasibility and efficacy of cyclophosphamide, vincristine, doxorubicin, and methotrexate (CODOX-M)/ifosfamide, etoposide, and cytarabine (IVAC) therapy in Japanese adult patients with Burkitt lymphoma (BL) and B cell lymphoma, unclassifiable, with features intermediate between diffuse large B cell lymphoma and BL (intermediate DLBCL/BL) have never been reported. The effects of adding rituximab to CODOX-M/IVAC have not been published either. Fifteen consecutive patients with a median age of 39 years were treated with modified CODOX-M/IVAC regimen (particularly, reducing the dose of methotrexate to 3 g/m 2 ) with or without rituximab at our institution. Although all patients developed grade 4 neutropenia and grade 3/4 thrombocytopenia/anemia, 93% had febrile neutropenia, 60% showed transaminase elevation, and 40% had mucositis/stomatitis (all grade 3), there were no treatment-related deaths. Two of nine patients treated with rituximab developed biphasic late-onset neutropenia. Thirteen patients (87%) showed complete responses. The remaining two patients had refractory disease; one had presented with peritoneal dissemination and complex chromosomal abnormalities, while the other had double IGH – MYC and IGH – BCL2 translocations. The estimated 5-year overall and progression-free survival were 87% each, with a median follow-up of 74 months. In conclusion, our modified CODOX-M/IVAC regimen is well tolerated and highly effective in Japanese adult patients with BL and intermediate DLBCL/BL, warranting a larger study for confirmation.