burkitt lymphoma

Multicenter Study of Risk-Adapted Therapy With Dose-Adjusted EPOCH-R in Adults With Untreated Burkitt Lymphoma

In the August 1, 2020 edition of Journal of Clinical Oncology, Mark Roschewski and colleagues report on the results of a trial using a risk-adapted strategy for advanced Burkitt lymphoma.

PURPOSE

To assess the utility of DA-EPOCH-R in patients with advanced Burkitt lymphoma

METHODS

The trial was a multicenter risk-adapted approach in adults with  Burkitt lymphoma, with newly diagnosed untreated disease. Low-risk patients received 3 cycles without CNS prophylaxis while high-risk patients received 6 cycles with intrathecal CNS prophylaxis or extended intrathecal treatment if leptomeningeal disease was present. The primary endpoint was EFS, and secondary endpoints were toxicity and predictors of EFS and OS.

RESULTS

Between 2020 and 2017, 113 patients were enrolled across 22 centers, and 87% (n=98) were high-risk. The median age was 49 (range, 18-86) years, and 62% were over the age of 40. Bone marrow and/or CSF was involved in 26% (n=29) and 25% (n=28) were HIV positive.  After 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 all 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 was observed in 16% of cycles, and tumor lysis syndrome was very rare.

The authors concluded “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 .”

Reference:

Multicenter Study of Risk-Adapted Therapy With Dose-Adjusted EPOCH-R in Adults With Untreated Burkitt Lymphoma

https://ascopubs.org/doi/full/10.1200/JCO.20.00303

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