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

الملخص EN

Background.

The outcome of HIV-associated non-Hodgkin lymphoma (NHL) has improved substantially in the highly active antiretroviral therapy (HAART) era.

However, HIV-Burkitt lymphoma (BL), which accounts for up to 20% of HIV-NHL, has poor outcome with standard chemotherapy.

Patients and Methods.

We retrospectively reviewed HIV-BL treated in the HAART era with the Magrath regimen (CODOX-M/IVAC±R) at four Canadian centres.

Results.

Fourteen patients with HIV-BL received at least one CODOX-M/IVAC±R treatment.

Median age at BL diagnosis was 45.5 years, CD4 count 375 cells/mL and HIV viral load (VL) <50 copies/mL.

Patients received PCP prophylaxis and G-CSF, 13 received HAART with chemotherapy and 10 rituximab.

There were 63 episodes of toxicity, none fatal, including: bacterial infection, n=20; grade 3-4 hematologic toxicity, n=14; febrile neutropenia, n=7; oral thrush; and ifosfamide neurological toxicity, n=1 each.

At a median followup of 11.7 months, 12 (86%) patients are alive and in remission.

All 10 patients who received HAART, chemotherapy, and rituximab are alive.

CD4 counts and HIV VL 6 months following BL therapy completion (n=5 patients) were >250 cells/mL and undetectable, respectively, in 4.

Conclusion.

Intensive chemotherapy with CODOX-M/IVAC±R yielded acceptable toxicity and good survival rates in patients with HIV-associated Burkitt lymphoma receiving HAART.