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

Table 2

Paradigms in the treatment of HIV/AIDS-related Burkitt lymphoma.

(i) Hyper-CVAD appears effective but may carry an increased risk of mortality in patients not receiving HAART or with poor performance status. The addition of rituximab to Hyper-CVAD has not shown significantly improved patient outcomes in HIV-BL.
(ii) CODOX-M/IVAC is associated with high CR rates but unacceptable neurotoxicity and myelosuppression. Modification of CODOX-M/IVAC has reduced toxicity while preserving efficacy. The addition of rituximab to the modified CODOX-M/IVAC regimen is under investigation by the AMC.
(iii) Although the PETHEMA regimen achieved excellent clinical outcomes, the addition of rituximab to this or a similar regimen has not been studied prospectively.
(iv) Results for the infusional R-EPOCH chemotherapy backbone (as reported by both the NIH and AMC) are promising, with high CR rates, and warrant further prospective investigation in larger trials.
(v) Patient screening for CNS involvement, along with appropriate CNS prophylaxis, is recommended and is particularly important with the use of R-EPOCH, as none of the agents in this regimen has significant penetration of the CNS.
(vi) There are insufficient data to support autologous stem cell transplantation as initial therapy for HIV-BL patients, though transplant may benefit a subset of patients with chemosensitive relapsed disease.
(vii) Supportive care for HIV-BL patients is important and includes HAART as well as prophylaxis against tumor lysis syndrome, CNS relapse, and opportunistic infections.