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.