CLINICAL ANALYSIS AND TREATMENT OUTCOME OF AIDS-RELATED BURKITT LYMPHOMA IN JAPAN

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Abstract

Background

With the widespread use of highly active antiretroviral therapy (HAART), the prognosis of HIV infected subjects has been improved, even if with AIDS-related lymphoma. Burkitt lymphoma progresses very rapidly, but highly intensive chemotherapy (e.g. CODOX-M/IVAC, hyper-CVAD/MA) has been shown to be a promising strategy. In this time, AIDS-related lymphoma is treated with similarly to non-AIDS lymphoma; nevertheless, it is not clear whether the highly intensive regimens are feasible and beneficial for AIDS-related Burkitt or not. We conducted nationwide retrospective survey to clarify the clinical outcomes of AIDS-related Burkitt lymphoma.

Materials and methods

All AIDS-related Burkitt lymphoma newly diagnosed at center hospitals for HIV/AIDS in Japan during the period 2002–2010 were serially registered.

Results

We identified 33 patients; the median age was 41 (range, 26–70 years) and the male gender accounted for 97% of the patients (32/33). Twenty-three patients (70%) had history of AIDS and the median CD4 count was 205/mm3 (range, 3–488/mm3). Twenty-nine (88%) were diagnosed in advanced stage (III/IV), with bone marrow involvement in 16 (48%) and central nervous system infiltration in 7 (21%). Nineteen (58%) were treated with rituximab-contain regimen and 14 (42%) were not. As chemotherapy regimen, 6 (18%) were treated with CODOX-M/IVAC, 22 (67%) with hyper-CVAD/MA and 5 (15%) with other regimens. Of 19 patients treated with rituximab-contain regimen, none were treated with CODOX-M/IVAC. Response at the end of treatment among 32 assessable patients was as follows: CR: 24 (73%); PR: 2 (6%); SD: 1 (3%); PD: 5 (15%). The median follow-up was 17 months. Two-year OS of total patients was 68.1%. There was no significant difference between chemotherapy regimens with/without rituximab (P = 0.367). Two-year OS was 66.7% in CODOX-M/IVAC and 71.6% in hyper-CVAD/MA (P = 0.724). There were a few patients with treatment-related death.

Conclusions

The favorable overall outcomes of AIDS-related Burkitt lymphoma were shown in this study. The addition of rituximab to highly intensive chemotherapy has not shown to be beneficial for AIDS-related Burkitt lymphoma. We now conduct prospective a clinical trial to optimize the treatment strategy for AIDS-related Burkitt lymphoma.

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