Institut Catala d'Oncologia-Hospital Germans Trias i Pujol. Josep Carreras Research Institute-Badalona. Universitat Autonoma de Barcelona.
Hospital Universitario de Donostia. Donostia.
Haematologica. 2024 Feb 1;109(2):543-552. doi: 10.3324/haematol.2023.283342.
High dose-intensive or infusional intermediate-dose immunochemotherapy is highly effective treatment for Burkitt lymphoma irrespective of human immunodeficiency virus (HIV) infection. However, toxicities of these regimens are relevant, especially in older adults and elderly patients. The prospective multicenter BURKIMAB14 trial included four to six blocks of immunochemotherapy according to stage (localized: 1 and 2 non-bulky; advanced: 2 bulky, 3, 4) and age, with dose reduction in patients >55 years old. Dose-intensity of chemotherapy was reduced in patients ≤55 years old after achieving complete metabolic response (CMR). Their outcomes were compared with those of similar patients included in the former BURKIMAB08 trial, in which there was no dose reduction. CMR was attained in 86 of 107 (80%) patients (17/19 in localized stages and 69/88 in advanced stages). Patients from the BURKIMAB14 trial ≤55 years old showed similar overall survival (OS), fewer infections and cytopenias than patients from the BURKIMAB08 trial. Patients >55 years old had a significantly higher treatment- related mortality despite dose reduction of chemotherapy. With a median follow-up of 3.61 years the 4-year OS probability was 73% (range, 63-81%). Age (≤55 vs. >55 years) and stage (localized vs. advanced) had prognostic significance. No significant differences in OS were observed in HIV-positive versus HIV-negative patients. The results of BURKIMAB14 are similar to those of other dose-intensive immunochemotherapy trials. Age >55 years and advanced stage, but not HIV infection, were associated with poor survival. Dose reduction of chemotherapy in young adults in CMR is safe and does not impact outcomes (clinicaltrials gov. Identifier: NCT05049473).
高剂量强化或输注型中剂量免疫化疗对伯基特淋巴瘤高度有效，无论人类免疫缺陷病毒（HIV）感染情况如何。然而，这些方案的毒性是相关的，特别是在老年人和老年患者中。前瞻性多中心 BURKIMAB14 试验根据分期（局限性：1 和 2 非肿块；晚期：2 肿块、3、4）和年龄包括四到六个免疫化疗疗程，并在患者年龄>55 岁时减少剂量。在达到完全代谢缓解（CMR）后，≤55 岁的患者减少化疗剂量强度。他们的结果与之前的 BURKIMAB08 试验中类似患者的结果进行了比较，其中没有剂量减少。在 107 例患者中（局限性 17 例，晚期 69 例）有 86 例（80%）达到 CMR。来自 BURKIMAB14 试验的≤55 岁患者的总生存率（OS）、感染和细胞减少症发生率与 BURKIMAB08 试验的患者相似。尽管化疗剂量减少，但>55 岁的患者治疗相关死亡率显著更高。中位随访 3.61 年后，4 年 OS 概率为 73%（范围 63-81%）。年龄（≤55 岁与>55 岁）和分期（局限性与晚期）具有预后意义。HIV 阳性与 HIV 阴性患者的 OS 无显著差异。BURKIMAB14 的结果与其他剂量强化免疫化疗试验相似。年龄>55 岁和晚期，但不是 HIV 感染，与生存不良相关。在 CMR 中减少年轻患者的化疗剂量是安全的，不会影响结果（clinicaltrials.gov. Identifier：NCT05049473）。
