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Session 108 Poster Abstracts
Opportunistic Malignancies: Kaposi's Sarcoma and Lymphomas
Wednesday, 1:30 - 3:30 pm
Poster Hall


787    
The Short and Intensive B-ALL Protocol Is a Highly Effective Regimen in Patients with AIDS-associated Burkitt or Burkitt-like Lymphoma
C Hoffmann1, E Wolf*2, G Faetkenheuer3, C Wyen3, H J Stellbrink4, J van Lunzen4, A Stoehr5, A Plettenberg5, H Jaeger6, R Noppeney7, D Hoelzer8, and H A Horst1
1Univ. Hosp. of Schleswig-Holstein, Campus Kiel, Germany; 2MUC Res., Munich, Germany; 3Univ. of Cologne, Germany; 4Univ. Hosp. of Eppendorf, Hamburg, Germany; 5Hosp. St. Georg, Hamburg, Germany; 6KIS–Curatorium for Immunedeficiency, Munich, Germany; 7Univ. of Essen, Germany; and 8Univ. of Frankfurt, Germany

Background: Burkitt- or Burkitt-like lymphoma (BL/BLL) accounts for 20 to 40% of AIDS-related lymphoma. Although it often occurs in a less immunosuppressed setting than other AIDS-related lymphoma, the outcome is usually very poor with complete remission rates of 40 to 50% and a median survival of <1 year. We compared patients with BL/BLL receiving an intensified chemotherapy protocol with patients treated with CHOP.

Methods: Cohort study of all patients with histologically confirmed BL/BLL diagnosed between 1990 and 2003 in 6 German HIV centers. Protocol was adapted from the GMALL Study Group (B-NHL 86/90), consisting of six alternating cycles (3 x cycle A, 3 x cycle B) of polychemotherapy after a prephase treatment of cyclophosphamide (CP) and prednisone. During cycle A, VM26, ifosphamide (IFO), methotrexate (MTX), cytarabine (Ara-C), vincristine, and dexamethasone are given. During cycle B, Ara-C, VM26 and IFO are replaced by doxorubicine and cyclophosphamide.

Results:  Of 62 patients with BL/BLL, 51  were identified who received either CHOP (group A, n = 32) or a modified B-ALL protocol (group B, n = 19). Median CD4 count at BL/BLL diagnosis was 210/µL, 22% had a prior AIDS event. The majority of the pts presented with advanced Ann Arbor stage (IV: 68%), and extranodal involvement (78%). In group B, median CD4 count at baseline was significantly higher (254 vs 117/µl, p= 0.004) with more patients receiving HAART after BL/BLL diagnosis (10/16 vs 10/32, p= 0.06). Significantly more patients of group B achieved CR (82% vs 39%, p= 0.006, intent-to-treat-analysis). Adjusting for baseline CD4 cells there still a trend for better outcome in group B. There was also a trend for improved 1-year survival in group B with 70% (Kaplan-Meier estimate) vs 42% in group A (p = 0.11; Breslow-Gehan test). One treatment-related death was observed in group B, compared to 3 deaths in group A. In multivariate analysis, B-ALL protocol by itself was not significantly associated with a survival benefit, but CR (HR = 0.22)--besides Ann Arbor stages I-III (HR 0.20) and no prior AIDS event (HR = 0.15)--were significant predictors (p <0.05) for prolonged survival.

Conclusions:  The short and intensive B-ALL-protocol may be feasible in HIV-infected patients with Burkitt or Burkitt-like lymphoma. These preliminary data suggest that outcome is improved compared to patients treated with "standard" CHOP chemotherapy. In the era of HAART, more intensive chemotherapy regimens should be considered in patients with highly aggressive lymphomas.

Keywords: Burkitt-Lymphoma; Lymphoma