Boosting Blood Cancer Survival

Burkitt lymphoma responded to low intensity therapy

/ Author:  / Reviewed by: Robert Carlson, M.D Beth Bolt, RPh

(RxWiki News) Lymphomas are blood cancers that start in the cells of the immune system. Burkitt’s lymphoma is a particularly aggressive form of the disease. New research may have discovered a better way to treat it.

National Cancer Institute (NCI) researchers have found that lower intensity chemotherapy was more effective than higher concentrations of medications for treating adults with Burkitt’s lymphoma.

The lower dosing helped patients live longer without the disease getting worse.

"See your doctor if you notice a lot of bruising."

Wyndham H. Wilson, MD, PhD, head of NCI's Lymphoma Therapeutics Section, and colleagues conducted this trial at NIH's Clinical Center.

Standard treatment for Burkitt’s lymphoma involves high doses of chemotherapy agents which can be very toxic. This standard therapy, according to the researchers, cures only about 60 percent of adult patients, and the toxic treatment-related side effects can be fatal.

Burkitt’s lymphoma is the most aggressive form of lymphoma that can develop in both children and adults. Cure rates for children are about 90 percent, but adults fare much worse.

The goal of this study was to find more effective and less toxic treatment regimens for adult Burkitt’s lymphoma patients.

The researchers examined the effectiveness of two variations of a chemotherapy regimen known as EPOCH-R, made up of etoposide (brand names Toposar and VePesid), prednisone, vincristine  (Oncovin), cyclophosphamide (Cytoxan, Neosar), doxorubicin (Hydrodoxorubicin) and rituximab (Rituxan).

This regimen delivers longer exposures to lower doses of these agents as opposed to shorter exposures to higher doses of the medications.

Between November 2000 and December 2009, 30 patients with untreated Burkitt’s lymphoma were enrolled.

Patients received one of the EPOCH-R regimens based on their HIV (human immunodeficiency virus) status. Burkitt’s lymphoma is seen in AIDS patients whose immune systems are compromised.

HIV-negative patients received dose-adjusted (DA)-EPOCH-R, and HIV-positive patients received the short course (SC) variant of EPOCH-R.

SC-EPOCH-R is a lower intensity regimen than DA-EPOCH.

Patients in both groups had excellent outcomes.

After a median follow-up of 86 months, 95 percent of patients who received the DA-EPOCH-R therapy saw no worsening of their disease, and 100 percent of them were still alive.

At a median follow-up of 73 months, 100 percent of the SC-EPOCH-R patients were progression-free (disease had not worsened) and 90 percent were alive.

"The toxicity of EPOCH-R-based treatment in Burkitt's lymphoma is considerably less than that reported with standard Burkitt regimens," Dr. Wilson said in a news release announcing the results. "Furthermore, these two regimens were highly effective in adult patients, who have significantly worse outcomes than children."

This study was published November 14 in the New England Journal of Medicine.

The National Cancer Institute supported the research. No author reported a potential conflict of interest.

Review Date: 
November 14, 2013
Last Updated:
December 30, 2013