Modified cyclophosphamide, vincristine, doxorubicin, and methotrexate (CODOX-M)/ifosfamide, etoposide, and cytarabine (IVAC) therapy with or without rituximab in Japanese adult patients with Burkitt lymphoma (BL) and B cell lymphoma, unclassifiable, with features intermediate between diffuse large B cell lymphoma and BL
Modified cyclophosphamide, vincristine, doxorubicin, and methotrexate (CODOX-M)/ifosfamide, etoposide, and cytarabine (IVAC) therapy with or without rituximab in Japanese adult patients with Burkitt lymphoma (BL) and B cell lymphoma, unclassifiable, with features intermediate between diffuse large B cell lymphoma and BL
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DOI：
10.1007/s12185-010-0728-0
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发表时间：
2010-12-01
影响因子：
2.1
通讯作者：
Tobinai, Kensei
中科院分区：
文献类型：
--
作者：
Maruyama, Dai;Watanabe, Takashi;Tobinai, Kensei
尚未报告环磷酰胺、长春新碱、多柔比星和甲氨蝶呤（CODOX-M）/异环磷酰胺、依托泊苷和阿糖胞苷（IVAC）治疗Burkitt淋巴瘤（BL）和B细胞淋巴瘤（不可分类）、特征介于弥漫性大B细胞淋巴瘤和BL之间（中度DLBCL/BL）的日本成人患者的可行性和疗效。在CODOX-M/IVAC中加入利妥昔单抗的效果也尚未发表。15例中位年龄为39岁的连续患者在我们的机构接受了改良的CODOX-M/IVAC方案（特别是将甲氨蝶呤的剂量降低至3 g/m2）联合或不联合利妥昔单抗治疗。尽管所有患者均发生4级中性粒细胞减少和3/4级血小板减少/贫血，93%发生发热性中性粒细胞减少，60%出现转氨酶升高，40%发生粘膜炎/口腔炎（均为3级），但无治疗相关死亡。9例接受利妥昔单抗治疗的患者中有2例发生双相迟发性中性粒细胞减少症。13例患者（87%）显示完全缓解。其余两名患者患有难治性疾病;一名患者出现腹膜播散和复杂染色体异常，另一名患者出现IGH-MYC和IGH-BCL 2双易位。估计的5年总生存率和无进展生存率均为87%，中位随访时间为74个月。总之，我们改良的CODOX-M/IVAC方案在日本成人BL和中度DLBCL/BL患者中耐受性良好且高度有效，需要进行更大规模的研究进行确认。
The feasibility and efficacy of cyclophosphamide, vincristine, doxorubicin, and methotrexate (CODOX-M)/ifosfamide, etoposide, and cytarabine (IVAC) therapy in Japanese adult patients with Burkitt lymphoma (BL) and B cell lymphoma, unclassifiable, with features intermediate between diffuse large B cell lymphoma and BL (intermediate DLBCL/BL) have never been reported. The effects of adding rituximab to CODOX-M/IVAC have not been published either. Fifteen consecutive patients with a median age of 39 years were treated with modified CODOX-M/IVAC regimen (particularly, reducing the dose of methotrexate to 3 g/m(2)) with or without rituximab at our institution. Although all patients developed grade 4 neutropenia and grade 3/4 thrombocytopenia/anemia, 93% had febrile neutropenia, 60% showed transaminase elevation, and 40% had mucositis/stomatitis (all grade 3), there were no treatment-related deaths. Two of nine patients treated with rituximab developed biphasic late-onset neutropenia. Thirteen patients (87%) showed complete responses. The remaining two patients had refractory disease; one had presented with peritoneal dissemination and complex chromosomal abnormalities, while the other had double IGH-MYC and IGH-BCL2 translocations. The estimated 5-year overall and progression-free survival were 87% each, with a median follow-up of 74 months. In conclusion, our modified CODOX-M/IVAC regimen is well tolerated and highly effective in Japanese adult patients with BL and intermediate DLBCL/BL, warranting a larger study for confirmation.