What are the NCCN-recommended chemotherapy regimens for the Burkitt lymphoma form of non-Hodgkin lymphoma (NHL)?

Updated: Jun 12, 2019
  • Author: Priyank P Patel, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Answer

Answer

Because of the complexity of the disease, NCCN guidelines recommend that treatment of Burkitt lymphoma be given at centers with expertise in the management of the disease. Recommended chemotherapy regimens for low-risk disease include the following:

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

  • Dose-adjusted EPOCH (etoposide, prednisone, vincristine [Oncovin], cyclophosphamide, doxorubicin [hydroxydaunorubicin]) + rituximab (minimum three cycles with one additional cycle beyond complete remission (regimen includes intrathecal methotrexate) 

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

Recommended combination regimens for high-risk disease include the following:

  • CODOX-M (original or modified) alternating with IVAC (ifosfamide, cytarabine, etoposide, and intrathecal methotrexate) ± rituximab
  • Dose-adjusted EPOCH + rituximab (for high-risk patients not able to tolerate aggressive treatments); regimen includes intrathecal methotrexate
  • HyperCVAD (cyclophosphamide, vincristine, doxorubicin, and dexamethasone) alternating with high-dose methotrexate and cytarabine + rituximab (regimen includes intrathecal therapy)

Other treatment recommendations are as follows [1] :

  • Enrollment in available clinical trials for all patients

  • CHOP is not considered adequate therapy

  • Central nervous system prophylaxis with systemic and/or intrathecal chemotherapy with methotrexate and/or cytarabine

  • Prophylaxis for tumor lysis syndrome is mandatory


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