What induction and second-line therapy regimens are used in the treatment of Burkitt lymphoma?

Updated: Feb 23, 2021
  • Author: Mohammad Muhsin Chisti, MD, FACP; Chief Editor: Emmanuel C Besa, MD  more...
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Answer

Induction therapy for low-risk Burkitt lymphoma includes the following:

  • CODOX-M (original or modified) (cyclophosphamide, doxorubicin, vincristine with intrathecal methotrexate and cytarabine followed by high-dose systemic methotrexate) ± rituximab (3 cycles)
  • Dose-adjusted EPOCH (etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin) + rituximab (minimum 3 cycles with one additional cycle beyond CR) (regimen includes intrathecal methotrexate) (Data are for patients without CNS disease.)
  • HyperCVAD (cyclophosphamide, vincristine, doxorubicin, and dexamethasone) alternating with high-dose methotrexate and cytarabine + rituximab (regimen includes intrathecal therapy)

Induction therapy for high-risk Burkitt lymphoma includes the following:

• CODOX-M (original or modified) (cyclophosphamide, doxorubicin, vincristine with intrathecal methotrexate and cytarabine followed by high-dose systemic methotrexate) alternating with IVAC (ifosfamide, cytarabine, etoposide, and intrathecal methotrexate) ± rituximab

• Dose-adjusted EPOCH (etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin) + rituximab (for high-risk patients not able to tolerate aggressive treatments) (regimen includes intrathecal methotrexate) (Data are for patients without CNS disease.)

• HyperCVAD (cyclophosphamide, vincristine, doxorubicin, and dexamethasone) alternating with high-dose methotrexate and cytarabine + rituximab (regimen includes intrathecal therapy)

Second-line therapy (for patients with dsease relapse >6 mo after appropriate first-line therapy)

While no definitive second-line therapies exist, limited data support the following regimens:

  • Dose-adjusted EPOCH (etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin) + rituximab (minimum 3 cycles with one additional cycle beyond CR) (regimen includes intrathecal methotrexate) (Data are for patients without CNS disease.)
  • RICE (rituximab, ifosfamide, carboplatin, etoposide); intrathecal methotrexate if have not received previously
  • RIVAC (rituximab, ifosfamide, cytarabine, etoposide); intrathecal methotrexate if have not received previously
  • RGDP (rituximab, gemcitabine, dexamethasone, cisplatin)High-dose cytarabine + rituximab

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