Paradigms and Controversies in the Treatment of HIV-Related Burkitt Lymphoma

Table 1

Comparison of trials/series including patients with HIV-BL.

Chemotherapy regimen (reference)	Number of patients	Patient characteristics	ORR (%)	CRR (%)	OS/EFS	Comments
Hyper-CVAD [10]	13	6 with BL, 7 with L3-ALL; 31% with preexisting HIV; median CD4: 77/μL 23% CSF+	100	92	48% OS at 2 years	HAART appeared to improve outcome; CNS ppx: alternating MTX and Ara-C × 16 total
CODOX-M/IVAC [14]	8	88% with stage IV disease; median CD4: 149/μL 21% CSF+	N/A	63	57% EFS at 2 years	Impact of HAART unclear; CNS ppx: Ara-C (x2) and MTX with each cycle
DA-EPOCH-R [21]	8	56% with stage III or IV; 76% with extranodal disease; CD4 count data N/A; proportion CSF+ N/A	100	100	96% EFS at 35 mo.	HAART use unclear; CNS ppx: MTX × 6 total
DA-EPOCH-R [23] Concurrent	51*	25% with HIV-BL*; 79% with advanced stage; median CD4: 181–194/μL	88	73	70% OS at 2 years	CRR for HIV-BL: 63% (10/16)
Sequential	55*	CNS ppx and HAART at discretion of treating physician	77	55	67% OS at 2 years	CRR for HIV-BL: 82% (9/11)
PETHEMA [25]	19	58% with stage III or IV; 89% with preexisting HIV; 58% with CD4 count >200/μL 5% CSF+	88	88	77% OS at 2 years	HAART mandatory; CNS ppx: MTX, Ara-C, Dex × 8

HIV: human immunodeficiency virus; HIV-BL: HIV/AIDS-related Burkitt lymphoma; ORR: overall response rate; CRR: complete response rate; OS: overall survival; EFS: event-free survival; L3-ALL: Burkitt cell acute lymphoblastic lymphoma; HAART: highly active antiretroviral therapy; CSF: cerebrospinal fluid; CNS: central nervous system; MTX: methotrexate; Ara-C: cytarabine; Dex: dexamethasone; N/A: not available. Please refer to text for explanation of chemotherapy regimen abbreviations.
*Most patients treated as part of AMC 034 had HIV/AIDS-related DLBCL (see text for further explanation).