Chemoimmunotherapy with hyper-CVAD plus rituximab for the treatment of adult Burkitt and Burkitt-type lymphoma or acute lymphoblastic leukemia

BACKGROUND. Adult Burkitt-type lymphoma (BL) and acute lymphoblastic leukemia (B-ALL) are rare entities composing 1% to 5% of non-Hodgkin lymphomas NHL) or ALL. Prognosis of BL and B-ALL has been poor with conventional NHL or ALL, regimens, but has improved with dose-intensive regimens. METHODS. To evaluate the addition of rituximab, a CD20 monoclonal antibody, to intensive chemotherapy in adults with BL, or B-ALL, 31 patients with newly diagnosed BL or B-ALL received the hyper-fractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone (hyper-CVAD) regimen with rituximab. Their, median age was 46 years; 29% were 60 years or older. Rituximab 375 mg/m(2) was given oil Days 1 and 11 of hyper-CVAD courses and oil Days 1 and 8 of metho-trexate and cytarabine courses. RESULTS. Complete remission (complete response [CRJ) was achieved in 24 of 28 (86%) evaluable patients; 3 had a partial response, and 1 had resistant disease. There were no induction deaths. The 3-year overall survival (OS), event-free survival, and disease-free survival rates were 89%, 80%, and 88%, respectively. Nine elderly patients achieved CR with all of them in continuous CR (except 1 death in CR from infection), with a 3-year OS rate of 89%. multivariate analysis of current and historical (those treated with hyper-CVAD alone) groups identified age and treatment with rituximab as favorable factors. CONCLUSIONS. The addition Of rituximab to hyper-CVAD may improve outcome in adult BL or B-ALL. particularly in elderly patients.