What Is the First-Line Treatment for Burkitt's Lymphoma?
Burkitt's lymphoma requires prompt initiation of systemic therapy. First-line management follows a risk-stratified approach, with treatment intensity calibrated to the extent of disease.
Treatment Approach
First-line therapy consists of intensive multiagent immunochemotherapy with rituximab, with the number of cycles and inclusion of CNS-directed components guided by risk stratification. The complete regimen selection criteria, cycle counts, and prophylaxis algorithm are available in the full structured protocol.
Treatment Goal
Achievement of complete remission of lymphoma, confirmed by a negative PET scan.
References
DOI: 10.1182/blood.2019004099
- In 1996, Magrath and colleagues, at the National Cancer Institute (NCI), published their experience with cyclophosphamide, doxorubicin, vincristine, methotrexate, ifosfamide, cytarabine, and etoposide (CODOX-M/IVAC).
- The regimen includes both high-dose, systemically administered and intrathecal methotrexate and cytarabine to treat and prevent disease recurrence in the CNS.
- Given the improvement in outcomes with its use in aggressive lymphoma, rituximab has been incorporated broadly into BL regimens.
- Low-risk patients received 3 cycles of dose-adjusted R-EPOCH without CNS prophylaxis, and high-risk patients received 6 cycles with intrathecal CNS prophylaxis or extended intrathecal treatment if the leptomeninges were involved.
- Patients were treated with 2 cycles beyond complete remission (6 to 8 total) with the exception of HIV patients who received 1 cycle beyond complete response (3 to 6 total) with 2 doses of rituximab administered with each cycle.
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