hematology and oncology
Burkitt Lymphoma
Treatment of Burkitt Lymphoma
Intensive chemotherapy Treatment must be initiated rapidly because these tumors grow rapidly. An intensive alternating regimen ofcyclophosphamide,vincristine,doxorubicin,methotrexate,ifosfamide,etoposide, andcytarabine(CODOX-M/IVAC) plusrituximabresults in a cure rate of>80% for children and adults < 60 years. For patients > 60 years, regimens such asrituximabplusetoposide,prednisone,vincristine(Oncovin), anddoxorubicin(dose-adjusted R-EPOCH) are also commonly used with success. For patients without CNS metastases, CNS prophylaxis (eg, with systemic and/or intrathecalmethotrexateand/orcytarabine) is essential. With treatment, Tumor Lysis and Cytokine Release Syndromes is common, and patients must receive IV hydration, If the patient presents with bowel obstruction secondary to tumor but the tumor is completely resected at initial diagnostic-therapeutic laparotomy, then aggressive therapy is still indicated, but fewer cycles may be needed. Patients at the end of treatment should have a complete metabolic response documented by PET or a complete response documented by CT scan and bone marrow biopsy. Outcome is poor in the 20% of patients in whom induction fails or relapse (typically in the first 12 months) occurs. Salvage therapy or clinical trials should be considered. 