PDF(Pubmed)
Abstract：
High dose-intensive or infusional intermediate-dose immunochemotherapy is highly effective treatment for Burkitt lymphoma irrespective of human immunodeficiency virus (HIV) infection. However, toxicities of these regimens are relevant, especially in older adults and elderly patients. The prospective multicenter BURKIMAB14 trial included four to six blocks of immunochemotherapy according to stage (localized: 1 and 2 non-bulky; advanced: 2 bulky, 3, 4) and age, with dose reduction in patients >55 years old. Dose-intensity of chemotherapy was reduced in patients ≤55 years old after achieving complete metabolic response (CMR). Their outcomes were compared with those of similar patients included in the former BURKIMAB08 trial, in which there was no dose reduction. CMR was attained in 86 of 107 (80%) patients (17/19 in localized stages and 69/88 in advanced stages). Patients from the BURKIMAB14 trial ≤55 years old showed similar overall survival (OS), fewer infections and cytopenias than patients from the BURKIMAB08 trial. Patients >55 years old had a significantly higher treatment- related mortality despite dose reduction of chemotherapy. With a median follow-up of 3.61 years the 4-year OS probability was 73% (range, 63-81%). Age (≤55 vs. >55 years) and stage (localized vs. advanced) had prognostic significance. No significant differences in OS were observed in HIV-positive versus HIV-negative patients. The results of BURKIMAB14 are similar to those of other dose-intensive immunochemotherapy trials. Age >55 years and advanced stage, but not HIV infection, were associated with poor survival. Dose reduction of chemotherapy in young adults in CMR is safe and does not impact outcomes (clinicaltrials gov. Identifier: NCT05049473).
摘要：
高剂量强化或输注中剂量免疫化学疗法是治疗伯基特淋巴瘤（BL）的高效治疗方法，与人类免疫缺陷病毒（HIV）感染无关。然而,这些方案的毒性是相关的，尤其是老年人和老年患者。前瞻性多中心BURKIMAB14试验根据阶段包括4-6组免疫化学疗法（局部：I和II型非庞大；晚期：II型庞大，III,IV）和年龄，剂量减少患者>55岁。≤55岁患者的化疗剂量强度降低。在达到完全代谢反应（CMR）后，并将其结果与前BURKIMAB08试验中包含的类似患者的结果进行比较，其中没有剂量减少。86/107（80％）患者达到CMR（局部阶段17/19，晚期阶段69/88）。来自BURKIMAB14试验的患者≤55岁。与BURKIMAB08试验的患者相比，显示出相似的OS，感染和血细胞减少更少。患者>55年。尽管化疗剂量减少,但治疗相关死亡率显著升高.中位随访时间为3.61年。4年。总生存期(OS)概率为73%(63%-81%).年龄（≤55岁。vs.>55年。)和阶段(本地化与晚期)具有预后意义。在HIV阳性和阴性患者。BURKIMAB14的结果与其他剂量密集型免疫化疗试验的结果相似。年龄>55岁。和高级阶段，但不是艾滋病毒感染，与不良生存有关。CMR中年轻人化疗剂量减少是安全的，不会影响预后。
