Rituxiamb Did Not Improve Clinical Outcomes In AIDS-Related Burkitt Lymphoma

With the widespread use of highly active antiretroviral therapy (HAART), the prognosis of HIV infected subjects has been improved, even if with AIDS-related lymphoma. Burkitt lymphoma progresses very rapidly, but highly intensive chemotherapy (e.g. CODOX-M/IVAC, hyper-CVAD/MA) has been shown to be a promising strategy. In this time, AIDS-related lymphoma is treated with similarly to non AIDS lymphoma, nevertheless it is not clear whether the highly intensive regimens are feasible and beneficial for AIDS-related Burkitt or not. We conducted nationwide retrospective survey to clarify the clinical outcomes of AIDS-related Burkitt lymphoma, especially in context with the usage of rituximab.

All AIDS-related Burkitt lymphoma newly diagnosed at center hospitals for HIV/AIDS in Japan during the period 2002–2010 were serially registered. The chart review was performed for all identified patients (pts) to obtain the following information; age, PS, CD4 count, previous AIDS, clinical stage, disease site, chemotherapy regimen, tumor response, and clinical outcomes. The effects of treatment and the clinical variables on overall survival (OS) were assessed.

We identified 33 pts; the median age was 41 (range, 26–70 years) and the male gender accounted for 97% of the pts (32/33). Twenty-three pts (70%) had history of AIDS and the median CD4 count was 205/mm³ (range, 3–488/mm³). Twenty-nine (88%) were diagnosed in advanced stage (III/IV), with bone marrow (BM) involvement in 16 (48%) and central nervous system (CNS) infiltration in 7 (21%). Nineteen (58%) were treated with rituximab-contain regimen and 14 (42%) were not. As chemotherapy regimen, 6 (18%) were treated with CODOX-M/IVAC, 22 (67%) with hyper-CVAD/MA and 5 (15%) with other regimens. Of 19 pts treated with rituximab-contain regimen, none were treated with CODOX-M/IVAC. Response at the end of treatment among 32 assessable pts was as follows: complete response (CR): 24 (73%); partial response (PR): 2 (6%); stable disease (SD): 1 (3%); progression disease (PD): 5 (15%). The median follow-up was 17 months. Two-year OS of total pts was 68.1%. There was no significant difference between chemotherapy regimens with/without rituximab (p =0.367). Two-year OS was 66.7% in CODOX-M/IVAC and 71.6% in hyper-CVAD/MA (p =0.724). There was no significant difference in OS by BM involvement and CNS infiltration, respectively. There were a few pts with treatment-related death.

The favorable overall outcomes of AIDS-related Burkitt lymphoma were shown in this study. Highly intensive chemotherapy regimens were feasible and brought high remission rate and long OS. The addition of rituximab to highly intensive chemotherapy has not shown to be beneficial for AIDS-related Burkitt lymphoma. We now conduct prospective a clinical trial to optimize the treatment strategy for AIDS-related Burkitt lymphoma.

No relevant conflicts of interest to declare.