What is the role of rituximab in the treatment of Burkitt lymphoma/Burkitt-like lymphoma (BL/BLL)?

Updated: Dec 20, 2019
  • Author: Ali H Kanbar, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Answer

Rituximab is a recombinant antibody that targets CD20 on the surface of B lymphocytes. Many studies have incorporated rituximab into the treatment of Burkitt lymphoma. When Oriol et al investigated the addition of rituximab to an intense chemotherapy regimen containing methotrexate, cyclophosphamide, vincristine, ifosfamide, and teniposide (NHL2002 protocol from GMALL [German Multicenter Study Group on Adult Acute Lymphoblastic Leukemia] study) in treating 36 patients, 19 (53%) of whom were HIV positive, complete remission (CR) rates were 88% for HIV-negative patients and 84% for HIV-positive patients. [61]

HIV-positive patients had a higher rate of mucositis and infectious diarrhea, but there was no statistically significant difference in 2-year overall survival between the 2 groups of patients. [61] The HIV-positive patients were all treated concurrently with highly active anti-retroviral therapy (HAART). [61] An improvement in the 3-year estimated survival, disease-free survival (DFS), and event-free survival (EFS) rates, particularly for the elderly, were seen in patients with Burkitt lymphoma receiving rituximab compared with historical controls who did not receive rituximab.

Rituximab has also been evaluated prospectively in small studies, in combination with hyper-CVAD (hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone) [28] and dose-adjusted EPOCH (etoposide, vincristine, doxorubicin, cyclophosphamide, and prednisone). [62] Complete remissions were seen in 86-100% of patients. Rituximab is therefore recommended in the treatment of BL patients, probably to be started with cycle 2, in order to decrease the risk of tumor lysis with the first cycle. CALGB is currently recruiting for a trial looking specifically at the role of rituximab (CALGB 10002).


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