HIV-Associated Burkitt Lymphoma: Good Efficacy and Tolerance of Intensive Chemotherapy Including CODOX-M/IVAC with or without Rituximab in the HAART Era

Table 2

Treatment-related toxicity in 14 patients with HIV-related Burkitt lymphoma receiving intensive chemotherapy with CODOX-M/IVAC ± rituximab.

Treatment-related toxicity	Grade 1-2		Grade 3-4
	𝑛 (episodes)	𝑛 (patients)	𝑛 (episodes)	𝑛 (patients)
Bacterial infection^1	5	3	15	4
Culture negative febrile neutropenia	—	—	7	7
Late neutropenia	5	4
Opportunistic infection^2	1	1	1	1
Grade 3 or 4 hematotoxicity	—	—	14	14
Cardiac syndrome^3	—	—	1	1
Stomatitis	3	3^4	—	—
Increased liver enzymes	2	2	—	—
Skin reaction	1	1	—	—
Peripheral neuropathy	1	1	1	1
Hallucinations	1	1	—	—
Neurotoxicity from ifosfamide	—	—	1	1
Chemotherapy dose reductions, delays, or changes due to toxicity^5	—	—	5	4

¹Included: bacteremia, 𝑛=12 episodes in 7 patients; urinary tract infection, 𝑛=4 in 2 patients; clostridium difficile diarrhea; 𝑛=3 in 3 patients; cellulitis, 𝑛=1 in 1patient.
²Oral thrush in 1 patient, presumed HSV esophagitis in 1 patient.
³Poorly defined cardiac syndrome; possible CHF following day 1 of cycle 1A, requiring admission to the Coronary Care Unit; patient recovered and completed treatment modified for other toxicities.
⁴In one of these patients the grade was not reported.
⁵Dose reductions/delays: Vincristine was held in cycle 2 due to severe peripheral neuropathy in one patient. One patient did not receive day 2 cyclophosphamide in cycle 1A due to developing a cardiac syndrome, in this patient cycle 2A was given without incident. One patient presented with a bilirubin level of 361 (normal < 20) umol/L from BL hepatic infiltration. He received dexamethasone 4 mg qid (day-1) followed by cyclophosphamide 1000 mg/m² (day1), and by day 6 the bilirubin was 67. He received the remainder of day 1-2 chemotherapy on day 7 (doxorubicin was given at 50% dose for increased bilirubin as per BCCA guidelines), rituximab on day 8 and high dose MTX on day 15. The bilirubin normalized by day 26. The patient who had a cardiac syndrome with cycle 1A later developed ifosfamide neurotoxicity with cycle 1B. He received 2 of 5 doses of ifosfamide, 3 of 5 doses of cytarabine, and completed cycle 1B with day 3–5 etoposide given on days 15–17. For cycle 2B, he received EPOCH-R. One patient receiving full Magrath doses had cycle 2A high dose MTX delayed by 6 days because of grade 4 neutropenia.