International Network for Cancer Treatment & Research, INCTR at Institut Pasteur, Rue England 642, B1180, Brussels, Belgium.
Curr Hematol Malig Rep. 2006 Dec;1(4):230-40. doi: 10.1007/s11899-006-0004-9.
Modern chemotherapy for childhood Burkitt lymphoma has its origins in Africa, where treatment evolved from one or two doses of single agents, which were curative in some patients, to combinations of non-cross-resistant drugs. Subsequently, in Europe and the United States, high-dose methotrexate, high-dose cytarabine, etoposide, and ifosfamide were found to be active in children with recurrent disease and were incorporated into primary therapy for patients with high-risk disease. These third-generation protocols produce overall cure rates around 90%. Therapy regimens for adults with Burkitt lymphoma have been developed by modifying second-generation pediatric protocols, and few investigators have used the third-generation pediatric regimens that include higher doses of methotrexate and additional agents. The weight of evidence strongly suggests that high-dose therapy with stem cell rescue in first remission cannot substitute for intensive therapy from the outset. Tolerance of intensive regimens by the elderly is a legitimate concern, but it seems appropriate to modify therapy only when necessary in individual patients. The value of rituximab and granulocyte colony-stimulating factor in patients undergoing intensive therapy (particularly the elderly) is worthy of further exploration. Because childhood diffuse large-B-cell leukemia (DLBCL) responds equally well to therapy for Burkitt lymphoma, more intensive therapy and intensive support might also give better results in at least a subset of adults with advanced DLBCL-perhaps defined on the basis of limited molecular profiling, which has provided new information about the categories of aggressive B-cell lymphomas.
现代儿童伯基特淋巴瘤的化疗起源于非洲，那里的治疗方法从一两种单一药物的剂量演变而来，这些药物在一些患者中具有治愈作用，后来发展为非交叉耐药药物的组合。随后，在欧洲和美国，高剂量甲氨蝶呤、高剂量阿糖胞苷、依托泊苷和异环磷酰胺被发现对复发性疾病的儿童有效，并被纳入高危疾病患者的初始治疗中。这些第三代方案的总体治愈率约为 90%。成人伯基特淋巴瘤的治疗方案是通过修改第二代儿科方案制定的，很少有研究人员使用包括更高剂量甲氨蝶呤和其他药物的第三代儿科方案。大量证据强烈表明，首次缓解时的高剂量治疗加干细胞挽救不能替代从一开始就进行强化治疗。老年患者能否耐受强化方案是一个合理的关注点，但似乎只有在个别患者有必要时才需要修改治疗方案。利妥昔单抗和粒细胞集落刺激因子在接受强化治疗（特别是老年患者）中的价值值得进一步探索。由于儿童弥漫性大 B 细胞白血病（DLBCL）对伯基特淋巴瘤的治疗反应同样良好，因此更强化的治疗和强化支持也可能在至少一部分晚期 DLBCL 成人患者中取得更好的结果——也许可以根据有限的分子分析来定义，这为侵袭性 B 细胞淋巴瘤的类别提供了新的信息。
