Thomas Deborah A, Faderl Stefan, O'Brien Susan, Bueso-Ramos Carlos, Cortes Jorge, Garcia-Manero Guillermo, Giles Francis J, Verstovsek Srdan, Wierda William G, Pierce Sherry A, Shan Jianqin, Brandt Mark, Hagemeister Fredrick B, Keating Michael J, Cabanillas Fernando, Kantarjian Hagop
Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, 77230, USA.
Cancer. 2006 Apr 1;106(7):1569-80. doi: 10.1002/cncr.21776.
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.
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 on Days 1 and 11 of hyper-CVAD courses and on Days 1 and 8 of methotrexate and cytarabine courses.
Complete remission (complete response [CR]) 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.
The addition of rituximab to hyper-CVAD may improve outcome in adult BL or B-ALL, particularly in elderly patients.
成人伯基特型淋巴瘤（BL）和急性淋巴细胞白血病（B-ALL）是罕见的疾病实体，占非霍奇金淋巴瘤（NHL）或急性淋巴细胞白血病的1%至5%。采用传统的NHL或急性淋巴细胞白血病治疗方案时，BL和B-ALL的预后较差，但采用剂量密集型方案后预后有所改善。
为评估在成人BL或B-ALL患者的强化化疗中加入CD20单克隆抗体利妥昔单抗的效果，31例新诊断的BL或B-ALL患者接受了含利妥昔单抗的超分割环磷酰胺、长春新碱、阿霉素和地塞米松（hyper-CVAD）方案。患者的中位年龄为46岁；29%为60岁及以上。在hyper-CVAD疗程的第1天和第11天以及甲氨蝶呤和阿糖胞苷疗程的第1天和第8天给予利妥昔单抗375mg/m²。
28例可评估患者中有24例（86%）实现完全缓解（完全缓解[CR]）；3例部分缓解，1例疾病耐药。无诱导死亡病例。3年总生存率（OS）、无事件生存率和无病生存率分别为89%、80%和88%。9例老年患者实现CR，所有患者均持续缓解（1例在CR期因感染死亡除外），3年OS率为89%。对当前组和历史组（仅接受hyper-CVAD治疗的患者）进行多因素分析，确定年龄和使用利妥昔单抗治疗为有利因素。
在hyper-CVAD方案中加入利妥昔单抗可能改善成人BL或B-ALL的预后，尤其是老年患者。
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