Brief, intense cycles of high-dose chemotherapy produced long-term, disease-free survival in more than half of adults treated for Burkitt’s small non-cleaved lymphoma and Burkitt’s leukemia, researchers from the Cancer and Acute Leukemia Group B report.
Burkitt’s lymphoma, also known as small noncleaved-cell lymphoma, is a fast-growing form of non-Hodgkins lymphoma (NHL) that most often occurs in young people aged 12-30 years. Burkitt’s leukemia, also known as B-cell acute lymphocytic leukemia, is the rarest form of acute lymphocytic leukemia (ALL).
These study findings represent an important treatment advance for these two similar, highly aggressive cancers, because patients usually relapse after standard chemotherapy treatment. “Nearly 50 percent of patients with NHL or ALL who received aggressive chemotherapy enjoy prolonged survival more than five years after treatment,” says the study’s lead author, Edward J. Lee, MD, of Maryland Oncology, P.A. According to Charles A. Schiffer, MD, another study author from Wayne State University School of Medicine in Detroit, “This is remarkable news for diseases generally considered to be fatal.”
Of the 54 patients included in the study’s final analysis, 43 (80 percent) achieved a complete response, and 28 patients (52 percent) are alive and in continuous complete remission more than five years after treatment. Responses were similar in patients with either disease.
However, researchers note that neurologic toxicity was substantial, and that the regimen has since been modified. Of the 75 patients initially enrolled in the study, 10 patients developed significant neurotoxicity after treatment. Ninety-three percent of patients experienced low white blood cell counts and 85 percent experienced a deficiency of blood platelets. There were 32 deaths as a result of treatment and/or disease, including seven deaths due to treatment-related complications.
The treatment strategy was based on a regimen that has worked well in children with both cancers, producing almost an 80 percent long-term, event-free survival. All patients in the study were to receive seven cycles of chemotherapy that included an initial five day course, followed by alternating 5-day cycles of two different multi-drug regimens at 3-week intervals. Researchers found that younger patients in the study tolerated the regimen better than older patients.
According to researchers, the two different cancers studied may be “differing expressions of the same disease.” Burkitt’s leukemia and Burkitt’s lymphoma each occur in about 3 percent of adults diagnosed with ALL or NHL.
“Brief-Duration High-Intensity Chemotherapy for Patients With Small Noncleaved-Cell Lymphoma or DFAB L3 Acute Lymphocytic Leukemia: Results of Cancer and Leukemia Group B Study 9251.” Edward J. Lee, MD, et al.; Maryland Oncology, P.A., Columbia, MD. Vol 19, No 20 (October 15) 2001, pp: 4015-4022.
The Journal of Clinical Oncology is the semi-monthly peer-reviewed journal of the American Society of Clinical Oncology (ASCO), the world's leading professional society representing physicians who treat people with cancer.
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