High Intensive Chemotherapy Regimen (LMB 86) for Saint Jude Stage IV AIDS-related Burkitt Lymphoma/Leukemia : A Prospective Study
L Galicier, Laurence Gérard*, C Fieschi, R Borie, V Meignin, M T Daniel, and E Oksenhendler
St Louis Hosp, Paris, France
Background: Prognosis of AIDS-related non-Hodgkin lymphoma has
improved since the introduction of HAART. Nevertheless Burkitt
lymphoma still has poor outcome in patients with bone marrow or central nervous
system (CNS) involvement when treated with standard-dose chemotherapy with an
overall survival <5% at 2 years. Preliminary studies have demonstrated high
complete response rate in small cohorts of AIDS-related Burkitt
lymphoma treated with intensive regimens.
Methods: We conducted a prospective, open-label trial
to evaluate the LMB 86 regimen in 63 HIV patients with newly diagnosed stage IV
(bone marrow or CNS involvement) Burkitt lymphoma
consecutively recruited between November 1992 and January 2006. Study endpoints
were overall and disease-free survival estimated using Kaplan-Meier method.
Prognosis factors were identified using a Cox proportional hazards regression
model. The study was completed in June 2006 and final results are presented.
Results: At Burkitt lymphoma
diagnosis, median CD4 cell count was 239x106/L (range, 16 to 1188x106/L):
16 had a plasma HIV RNA <50 copies/mL, and in 44 patients the median value for plasma HIV RNA
was 38,000 copies/mL (range, 599 to 3,281,900 copies/mL). Bone marrow and CNS involvement were present in 55
(80%) and 48 (76%) patients, respectively; 44 patients (70%) achieved a complete
response. With a median follow-up of 66 months (range, 6-165), 11 patients
relapsed. The estimated 2-year overall survival and disease-free survival were
47.1% (95%CI 34 to 59.1) and 67.8% (95%CI 51 to 80), respectively. A CD4 cell
count <200x106/L and an ECOG >2 at diagnosis were independently
associated with poor prognosis.
Conclusions: Intensive chemotherapy regimen is highly
effective in advanced HIV-related Burkitt lymphoma
and should be proposed for patients with bone marrow or CNS involvement.