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A new short intensive protocol BL-M-04 for therapy of Burkitt lymphoma in adults: intermediate results



A new short intensive protocol BL-M-04 for therapy of Burkitt lymphoma in adults: intermediate results



Gematologiya i Transfuziologiya 51(6): 3-11



The main aim of the new protocol was to improve the treatment efficiency for patients with Burkitt lymphoma (BL) by intensifying the therapy and contracting the duration of treatment. The study was carried out in 17 patients with the diagnosis of BL (12 men and 5 women aged 5-46 years; mean age 25 years), treated at Hematology Research Center in 2003-2005. Two patients presented with stage I (after S. B. Murphy), one with stage II, six with stage III, and eight with stage IV. Bone marrow involvement was detected in 5, neuroleukemia in 5 patients. The new protocol is based on modified pediatric protocol NHL-BFM-90 with methotrexate dose of 1.5 g/m(2). BL completely regressed in chemosensitive patients after 1-2 blocks irrespective of the initial size of the tumor, and therefore 4 blocks were planned (2 induction and 2 consolidating). The data on the highest sensitivity of the tumor to high-dose methotrexate and cytosar prompted the use of these drugs for the induction phase in order to attain the maximum cytoreducing effect. In order to attain remission, blocks A and C were used. Doxorubicin was added to block A and methotrexate to block C for intensification of therapy. Consolidating courses were similar to the induction ones. The interval between the courses was the same as previously (21 days). Seventeen patients received complete treatment according to BL-M-04 protocol. Remission has been attained in 94% patients; 88% patients are alive during the 1st complete remission (the median of observation 16.5 (5-27) months). Two patients died from chemotherapy complications: 1 from traumatic subdural hematoma in the presence of thrombocytopenia (40 x 10(9)/L) during remission of the underlying disease, the other died from fulminant candidal (Candida krusei) sepsis during remission induction. Total duration of treatment was 3-3.5 months. Unfavorable prognostic factors significantly increasing the number of complications were disease stage IV, ARF by the beginning of therapy, previous treatment, and a history of extensive (mutilating) interventions. We consider that this protocol leads to rapid regression of the tumor and accelerates the treatment due to intensification of chemotherapy with tolerable toxicity.

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Accession: 012938525

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