Prolonged complete remission following high dose chemotherapy of burkitt's lymphoma in relapse

Adult Burkitt’s lymphoma emerged as an AIDS-defining condition in the 1980s. We describe a case of HIV-associated adult Burkitt’s lymphoma diagnosed and treated with high-dose chemotherapy in our institution, complicated by unusual bilateral renal vein tumour thrombi and tumour lysis syndrome. We believe this unique case highlights the need for early recognition of current and potential complications on staging computed tomography imaging, as well as successful use of a high-dose chemotherapy regimen.

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Jejunal Perforation: A Rare Presentation of Burkitt’s Lymphoma—Successful Management

Case Reports in Oncological Medicine ◽

10.1155/2014/538359 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Samir Ranjan Nayak ◽

Ganni Bhaskara Rao ◽

Subramanya Sarma Yerraguntla ◽

Sisir Bodepudi

Keyword(s):

Malignant Tumors ◽

Burkitt’S Lymphoma ◽

High Dose Chemotherapy ◽

Interesting Case ◽

Burkitt's Lymphoma ◽

Emergency Laparotomy ◽

High Dose ◽

Successful Management ◽

Rare Presentation ◽

Uncommon Presentation

Malignant tumors of the small bowel presenting as acute abdomen are a rare occurrence. Burkitt’s lymphoma presenting as a surgical emergency needing emergency laparotomy is an uncommon presentation of this tumor. We present an interesting case of jejunal perforation as a first manifestation of Burkitt’s lymphoma which was successfully managed with surgical resection, high dose chemotherapy, and good supportive care.

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A clonally distinct recurrence of Burkitt's lymphoma at 15 years

Blood ◽

10.1182/blood.v88.4.1407.bloodjournal8841407 ◽

1996 ◽

Vol 88 (4) ◽

pp. 1407-1410 ◽

Cited By ~ 20

Author(s):

J Lister ◽

JA Miklos ◽

SH Swerdlow ◽

DW Bahler

Keyword(s):

Molecular Size ◽

Burkitt’S Lymphoma ◽

High Dose Chemotherapy ◽

Burkitt's Lymphoma ◽

Primary Lymphoma ◽

Second Primary ◽

High Dose ◽

Immunodeficiency Virus ◽

Pcr Products ◽

Polymerase Chain

A human immunodeficiency virus-negative male was successfully treated for two occurrences of Burkitt's lymphoma, 15 years apart. As consolidation of his second remission, he underwent high-dose chemotherapy with peripheral blood stem cell transplantation. In an effort to prove whether the second lymphoma was a relapse of the first or a second primary lymphoma, we obtained paraffin-embedded material from both lymphomas. DNA was extracted from this material and amplified by polymerase chain reaction (PCR) using consensus JH and VH region primers. Analysis of the PCR products, which mostly reflects VDJ joints, showed two sharp bands of different molecular size, proving the monoclonal nature of the lymphomas and suggesting that each had different Ig gene rearrangements. Sequencing of both PCR products showed a marked dissimilarity in nucleotide sequence in the clonally unique VDJ joint region, providing strong evidence for the separate cellular genesis of each lymphoma. These results suggest that late relapses of Burkitt's lymphoma should be examined for clonal distinctiveness. If the second lymphoma is distinct from the primary one, it might be treated as a primary lymphoma rather than as recurrent disease.

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Curability of Burkitt's lymphoma with high-dose cyclophosphamide-high-dose methotrexate therapy and intrathecal chemoprophylaxis.

Journal of Clinical Oncology ◽

10.1200/jco.1985.3.5.627 ◽

1985 ◽

Vol 3 (5) ◽

pp. 627-636 ◽

Cited By ~ 46

Author(s):

M P Sullivan ◽

I Ramirez

Keyword(s):

Side Effects ◽

Complete Remission ◽

Burkitt’S Lymphoma ◽

Burkitt's Lymphoma ◽

Disease Stage ◽

Infusion Therapy ◽

High Dose ◽

High Dose Methotrexate ◽

Dose Methotrexate ◽

High Doses

Twenty-four children with Burkitt's lymphoma were treated beginning May 1976 with a regimen alternating high doses of cyclophosphamide and methotrexate in induction and consolidation; only high doses of methotrexate were used in the maintenance phase. Throughout therapy, which was planned for 54 weeks, intrathecal chemoprophylaxis using methotrexate, cytosine arabinoside, and hydrocortisone was coordinated with the high-dose methotrexate infusion therapy to provide CNS chemoprophylaxis that maintained therapeutic methotrexate spinal fluid levels (greater than 10(-6) mol/L) for approximately 60 hours. Twenty-two (92%) of the 24 children attained complete remission; two (8.3%) patients attained only partial remission, failing therapy. Two children died of infection while in complete remission; two children relapsed on therapy. Actual survival is 75%; the median follow-up time is 38+ months (range, 1 1/2+ to 84+ months). Relapses correlated with Murphy disease stage as follows: stage I--0/3, stage II--2/7, stage III--2/10, and stage IV--0/2. Serious side effects and toxicities of chemotherapy occurred in ten patients (metabolic disturbances after rapid tumor lysis, two; infectious and/or febrile episodes following cyclophosphamide therapy, three; methotrexate side effects, four; and complications of intrathecal therapy, one). Results of this therapy are similar to those of the best regimens that have been reported. Treatment has been adapted for use in Burkitt's lymphoma by the Pediatric Oncology Group; the responsiveness of other B cell lymphomas of childhood to this treatment is also being determined.

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High-Dose Chemotherapy With Autologous Bone Marrow Rescue in Children With Poor-Risk Burkitt's Lymphoma: A Report From the European Lymphoma Bone Marrow Transplantation Registry

Blood ◽

10.1182/blood.v90.8.2921 ◽

1997 ◽

Vol 90 (8) ◽

pp. 2921-2930 ◽

Cited By ~ 65

Author(s):

Ruth Ladenstein ◽

Rachel Pearce ◽

Olivier Hartmann ◽

Catherine Patte ◽

Tony Goldstone ◽

...

Keyword(s):

Bone Marrow ◽

Bone Marrow Transplantation ◽

Marrow Transplantation ◽

Autologous Bone Marrow Transplantation ◽

Autologous Bone Marrow ◽

Burkitt’S Lymphoma ◽

High Dose Chemotherapy ◽

Burkitt's Lymphoma ◽

High Dose ◽

Autologous Bone

Abstract To evaluate the role of high-dose chemotherapy (HDC) followed by autologous bone marrow transplantation (ABMT) in children with poor-prognosis Burkitt's lymphoma, the European Lymphoma BMT registry was critically reviewed. Between February 1979 and July 1991, a selected group of 89 children (78 boys and 11 girls) were considered as ABMT candidates in 12 European cancer centers for the following reasons: poor initial response (PIR) to first-line chemotherapy in 28 patients, primary refractory disease (PRD) in nine patients, sensitive relapse (SR) in 38 patients, and resistant relapse (RR) in 14 patients. The median age at ABMT was 8.2 years (range, 2.8 to 16.2 years). Thus, this report reflects data for patients surviving the salvage attempt deemed appropriate for HDC/ABMT and who then actually underwent the transplant procedure. The median follow-up period after HDC/ABMT was 4.3 years (range, 2 to 12 years). The prognosis was dismal for PRD patients and those with RR, ie, all patients died within 1 year. The 5-year event-free survival (EFS) was 56.6% (P < .0001) for patients in partial remission (PR) and 48.7% (P = .002) for patients with SR. The toxic death rate was 11.1%. Continuous complete remissions (CRs) in 39.4% of these otherwise incurable children highlight the fact that HDC/ABMT was an effective complementary procedure after conventional-dose chemotherapy protocols used during the given period. In addition, these data show that patients with PRD or RR clearly had no advantage from this aggressive and cost-intensive procedure. It has to be considered that the need for HDC/ABMT has greatly diminished in parallel with the improvement in survival using the modern intensive pulsed CCT of current protocols. To further rescue patients failing to respond to modern protocols, new approaches appear necessary, ie, combinations of HDC with antibody-targeted therapy plus allogeneic BMT for the additional benefits of the potential graft-versus-lymphoma effect.

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Effective therapy for Burkitt's lymphoma: High-dose cyclophosphamide + high-dose methotrexate with coordinated intrathecal therapy

Cancer Chemotherapy and Pharmacology ◽

10.1007/bf00254980 ◽

1979 ◽

Vol 3 (2) ◽

Cited By ~ 11

Author(s):

Irma Ramirez ◽

MargaretP. Sullivan ◽

Yeu-ming Wang ◽

R.G. Martin ◽

J.J. Butler

Keyword(s):

Burkitt’S Lymphoma ◽

Effective Therapy ◽

Burkitt's Lymphoma ◽

Intrathecal Therapy ◽

High Dose ◽

High Dose Methotrexate ◽

Dose Methotrexate

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A multi-center prospective phase II study of high-dose chemotherapy in germ-cell cancer patients relapsing from complete remission

Annals of Oncology ◽

10.1023/a:1008328012040 ◽

1999 ◽

Vol 10 (12) ◽

pp. 1467-1474 ◽

Cited By ~ 45

Author(s):

S. Rodenhuis ◽

R. de Wit ◽

P.H.M. de Mulder ◽

H.J. Keizer ◽

D.T. Sleijfer ◽

...

Keyword(s):

Complete Remission ◽

Germ Cell ◽

Cancer Patients ◽

Phase Ii ◽

Phase Ii Study ◽

Cell Cancer ◽

High Dose Chemotherapy ◽

Germ Cell Cancer ◽

High Dose ◽

Prospective Phase

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Radiotherapy after High-Dose Chemotherapy Followed by Autologous Bone Marrow Transplantation in Patients with Intermediate or High-Grade Non-Hodgkin's Lymphoma

Tumori Journal ◽

10.1177/030089169608200408 ◽

1996 ◽

Vol 82 (4) ◽

pp. 335-338

Author(s):

Salvina Barra ◽

Almalina Bacigalupo ◽

Renzo Corvò ◽

Marina Guenzi ◽

Tindaro Scolaro ◽

...

Keyword(s):

Bone Marrow ◽

Bone Marrow Transplantation ◽

Complete Remission ◽

Autologous Bone Marrow Transplantation ◽

Autologous Bone Marrow ◽

High Dose Chemotherapy ◽

High Dose ◽

High Grade ◽

Bulky Disease ◽

Autologous Bone

Patients with intermediate or high-grade non-Hodgkin's lymphoma are rarely cured of their disease after the failure of conventional therapy. Autologous bone marrow transplantation (ABMT) offers such patients a new possibility of cure. Our purpose was to evaluate the usefulness of radiotherapy in these patients who did not achieve complete remission of disease after high-dose chemotherapy (HDCT) followed by ABMT or who had previous bulky disease. In this study we examined 10 patients: after HDCT+ABMT, 9 patients had persistent disease and 1 patient with previous bulky disease was in complete remission. All patients underwent involved-field radiotherapy administered by a 6-18 MV linear accelerator, total mean dose 4000 cGy (range, 3200-5000 cGy). At the end of radiotherapy we observed 6 complete responses and 4 progressions of disease outside the radiotherapy field. No serious side effects were observed. To date, of the 6 complete responses 2 have relapsed (after 9 and 11 months) and 4 are alive and disease free at 24 months (range, 8-39 months) after radiotherapy. In our opinion, radiotherapy is an effective treatment after HDCT+ABMT and may have a role in a prospective multidisciplinary approach.

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Burkitt’s Lymphoma and B-Cell Lymphoma Unclassifiable With Features Intermediate Between Diffuse Large B-Cell Lymphoma and Burkitt’s Lymphoma in Patients With HIV: Outcomes in a South African Public Hospital

Journal of Global Oncology ◽

10.1200/jgo.2015.002378 ◽

2017 ◽

Vol 3 (3) ◽

pp. 218-226 ◽

Cited By ~ 5

Author(s):

Gerhard Sissolak ◽

Matthew Seftel ◽

Thomas S. Uldrick ◽

Tonya M. Esterhuizen ◽

Nooroudien Mohamed ◽

...

Keyword(s):

South Africa ◽

B Cell ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Burkitt’S Lymphoma ◽

Burkitt's Lymphoma ◽

High Dose ◽

Baseline Serum ◽

Large B Cell Lymphoma ◽

Large B Cell

Purpose Burkitt’s lymphoma (BL) is a common HIV-associated lymphoma in South Africa. B-cell lymphoma unclassifiable with features intermediate between diffuse large B-cell lymphoma and Burkitt’s lymphoma (BL/DLBCL) also occurs in HIV infection. Outcomes of HIV-infected patients with BL or BL/DLBCL in a resource-constrained setting are not defined. Methods We performed a retrospective study of HIV-positive patients with BL or BL/DLBCL treated from 2004 to 2012 with curative intent at a publically funded academic medical center in South Africa. Differences between BL and BL/DLBCL, survival outcomes, and factors associated with survival were analyzed. Results There were 35 patients with either HIV-associated BL (24) or BL/DLBCL (11) who met study criteria. Median CD4+ T-lymphocyte count at lymphoma diagnosis was 188 cells/μL (range, 10 to 535 cells/μL). Patients with BL/DLBCL were significantly older and had less bone marrow involvement and lower baseline serum lactase dehydrogenase than patients with BL. Eighty-nine percent of patients presented with advanced disease, and 25% had baseline CNS involvement. Chemotherapy regimens consisted of cytoreduction with low-dose cyclophosphamide, vincristine, and prednisone followed by induction with vincristine, methotrexate, cyclophosphamide, doxorubicin and prednisone (LMB 86; 57%); hyperfractionated cyclophosphamide, vincristine, doxorubicin, dexamethasone, methotrexate, and cytarabine (hyper-CVAD; 20%); cyclophosphamide, doxorubicin, vincristine, and prednisone and high-dose methotrexate with leucovorin rescue on day 10 with accompanying prophylactic IT chemotherapy (Stanford regimen; 14%); and cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP-like; 9%) regimens. Twenty-three patients received CNS treatment or prophylaxis, and 31 received concurrent combination antiretroviral therapy. Two-year overall survival was 38% (95% CI, 22% to 54%) and 2-year event-free survival was 23% (95% CI, 11% to 38%), with no difference between histologic subtypes. Common causes of death were infection (41%) and CNS disease progression or systemic relapse (41%). Conclusion Cure of HIV-associated BL and BL/DLBCL with intensive regimens is possible in resource-limited settings, but lower toxicity regimens, improved CNS prophylaxis, and increased resources for supportive care are required.

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