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Intensive, Very Short-Term Chemotherapy for Advanced Burkitt’s Lymphoma in Children

From the Departments of Pediatric Oncology and Pathology, Istituto Nazionale Tumori, Milan, Italy.

Address reprint requests to Filippo Spreafico, MD, Istituto Nazionale per lo Studio e la Cura dei Tumori, Via Venezian 1, 20133 Milano, Italy; email: f.spreafico{at}istitutotumori.mi.it

PURPOSE: To improve the 63% event-free survival (EFS) achieved before 1986 in Murphy’s stage III to IV Burkitt’s lymphoma (BL), both chemotherapy and supportive care were intensified.

PATIENTS AND METHODS: From May 1987 to February 2001, 60 children, median age 9 years (range, 2.1 to 17 years), with advanced BL were enrolled onto two sequential institutional studies. From 1987 to 1992, 30 patients were stratified according to the absence (regimen IA, n = 19) or presence (regimen IB, n = 11) of bone marrow (BM) or CNS involvement. After 5-week cytoreductive chemotherapy consisting of vincristine, cyclophosphamide, doxorubicin, high-dose (HD) methotrexate (MTX), and intrathecal MTX or cytarabine, HD cytarabine and cisplatin were provided as a 4-day continuous infusion. Regimen IB was intensified by adding etoposide and HD ifosfamide and escalating MTX doses. Since 1992, regardless of BM or CNS status, 30 patients have been placed on regimen II, which is identical to IB but without ifosfamide. The scheduled duration of regimen II was 45 days.

RESULTS: EFS and disease-free survival at 5 years are 81% ± 5% and 87% ± 5%, respectively, for 59 assessable patients (73% ± 8% and 85% ± 7% for regimen IA + IB, 89% ± 6%, EFS and disease-free survival, for regimen II; median follow-up, 6.7 years; range, 0.6 to 13.5 years). Six patients, two of whom were receiving regimen II, died as a result of initial treatment failure or relapse, and five patients, none receiving regimen II, died as a result of treatment-related complications.

CONCLUSION: This 45-day intensive chemotherapy program is the shortest schedule for disseminated BL and overcomes previously recognized risk factors such as BM and CNS infiltration.

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