Rituximab Improves Overall Survival in Patients Treated with CODOX-M/IVAC for Burkitt Lymphoma (BL) and B-Cell Lymphoma, Unclassifiable, with Features Intermediate between Diffuse Large B-Cell Lymphoma and BL (BCL-U): A Single Center Experience and Review of the Literature

A. Prica¹, A. Pratzer², M. Cheung¹, K. Thompson³, E. Piliotis¹, N. L. Berinstein¹, K. Imrie¹, R. Pradhan⁴, A. Vyas⁴, Z. Ghorab⁴, D. Good⁴, L. Zhang¹, R. Buckstein^1*

¹Hematology/Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada.
²Feinberg School of Medicine, Northwestern University, Chicago, USA.
³Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada.
⁴Department of Pharmacy, Sunnybrook Health Sciences Centre, Toronto, Canada.

DOI: 10.4236/jct.2015.61001                

Abstract

Background: Dose-modified (dm) CODOX-M/IVAC is commonly used for Burkitt lymphoma (BL) and B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma (DLBCL) and BL (BCL-U; previously Burkitt-like lymphoma-BLL). Methods: We evaluated the clinical characteristics, outcomes and prognostic markers in patients treated with dmCODOX-M/IVAC+/- rituximab (R) at a single academic center. Results: 31 patients with BL (n = 21) or BCL-U (n = 10) were included. The median age was 45, and 90% were high risk. The 2-year overall survival (OS) and progression-free survival (PFS) were 69% and 62%, respectively, with no differences between BL and BCL-U. By multivariable analysis, rituximab use was significantly associated with improved OS (Hazard Ratio 0.15; 95% CI 0.04 - 0.56) while elevated LDH (Hazard Ratio 2.84, 95% CI 1.52 - 5.29) and rituximab use (Hazard Ratio 0.054, 95% CI 0.01 - 0.32) predicted PFS. Conclusion: DmCODOX-M/IVAC+/- R chemotherapy provides equivalent survival for both BL and BCL-U patients. The addition of rituximab improves overall and progression free survival and is recommended.

Keywords

Burkitt Lymphoma, Burkitt-Like Lymphoma, CODOX-M/IVAC, MYC, Rituximab

Conflicts of Interest

The authors declare no conflicts of interest.

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