Haematology-Oncology and Stem Cell Transplantation Unit, Fondazione 'G. Pascale,' IRCCS, Naples, Italy.
Br J Haematol. 2012 Jan;156(2):234-44. doi: 10.1111/j.1365-2141.2011.08947.x. Epub 2011 Nov 21.
Specific trials on adult Burkitt lymphoma (BL) and 'unclassifiable' lymphomas with features intermediate between BL and diffuse large B-cell lymphoma (BL/DLBCL) are advocated which include substantial numbers of older patients, to improve treatment feasibility, while countering risks of systemic and central nervous system (CNS) recurrences. We prospectively evaluated a modified CODOX-M/IVAC (CODOX-M: cyclophosphamide, vincristine, doxorubicin, high-dose methotrexate; IVAC: ifosfamide, etoposide and high-dose cytarabine) regimen by the addition of rituximab (R) and liposome-encapsulated cytarabine (D) to increase antitumour activity and halve the number of intrathecal treatments. Thirty adults (40% >60years) with BL (n=15) and BL/DLBCL (n=15) were accrued. Primary endpoints were progression-free survival (PFS), CNS recurrence, and liposomal cytarabine-associated toxicity. Eighty percent of patients received the whole treatment programme, the remaining cases received at least three full courses. Application of the RD-CODOX-M/IVAC regimen resulted in remarkable 4-year PFS (78%) and complete remission (CR) rates (93%). However, PFS was significantly lower in patients older than 60years as compared to younger ones (49%vs 93%, P=0·03; median, 36months), despite high actual dose-intensity, CR rate and tolerability. Reduced-intensity intratechal prophylaxis through liposomal cytarabine was effective because the CNS failure rate was low (3·4%) and without severe neurological toxicities. The RD-CODOX-M/IVAC strategy is feasible and highly effective, but improving outcomes in elderly patients remains a priority.
建议进行专门针对成人伯基特淋巴瘤（BL）和具有 BL 和弥漫性大 B 细胞淋巴瘤（BL/DLBCL）之间特征的“未分类”淋巴瘤的临床试验，包括大量老年患者，以提高治疗可行性，同时降低全身和中枢神经系统（CNS）复发的风险。我们前瞻性地评估了一种改良的 CODOX-M/IVAC（CODOX-M：环磷酰胺、长春新碱、多柔比星、高剂量甲氨蝶呤；IVAC：异环磷酰胺、依托泊苷和高剂量阿糖胞苷）方案，通过添加利妥昔单抗（R）和脂质体阿糖胞苷（D）来提高抗肿瘤活性并将鞘内治疗次数减半。共入组了 30 名 BL（n=15）和 BL/DLBCL（n=15）成人患者（40%>60 岁）。主要终点是无进展生存期（PFS）、CNS 复发和脂质体阿糖胞苷相关毒性。80%的患者接受了整个治疗方案，其余患者接受了至少三个完整疗程。应用 RD-CODOX-M/IVAC 方案后，4 年 PFS（78%）和完全缓解（CR）率（93%）非常显著。然而，与年轻患者相比，年龄大于 60 岁的患者 PFS 明显较低（49%比 93%，P=0·03；中位数，36 个月），尽管实际剂量强度高、CR 率和耐受性好。通过脂质体阿糖胞苷进行低强度鞘内预防是有效的，因为 CNS 失败率低（3·4%）且无严重神经毒性。RD-CODOX-M/IVAC 策略是可行且非常有效的，但改善老年患者的预后仍是当务之急。
