Rituximab Boosts Burkitt’s Lymphoma Patient Survival

Adding rituximab to chemotherapy may extend Burkitt’s lymphoma event-free and overall survival

medwireNews: Phase III trial findings support the use of rituximab alongside chemotherapy in HIV-negative patients with untreated Burkitt’s lymphoma, demonstrating significantly better event-free survival (EFS) after 3 years.

“We noted these results without limitation of age (not restricted to young adult patients) and without increased toxic effects”, emphasize Vincent Ribrag, from Université Paris Saclay in Villejuif, France, and co-authors in The Lancet.

After a median of 38 months of follow-up, the primary endpoint of 3-year EFS was achieved by 75% of the 128 patients randomly assigned to receive rituximab 375 mg/m2 on day 1 and 6 of their first two cycles of COPADM (fractionated cyclophosphamide , adriamycin, high-dose methotrexate , prednisone and vincristine ) versus 62% of the 129 given chemotherapy alone.

Overall survival (OS) was also significantly better in the combined treatment group at the 3-year checkpoint, at 83% versus 70% of controls.

And after adjusting for stratification by disease severity, based on central nervous system and bone marrow involvement, the hazard ratios for EFS and OS were significantly in favour of combined treatment, at 0.59 and 0.51, respectively.

“Adverse events did not differ between the two treatment groups”, the authors say, with minor and major infections reported in 15% and 17% of rituximab-treated patients, respectively, versus 16% and 15% of controls.

At least one grade 3 or 4 nonhaematological side effect was reported for 18% and 17% of the rituximab and control groups, respectively. Grade 4 neutropenia lasted for a median of 3.38 versus 3.31 days per cycle.

In multivariate analysis, concentration of albumin 30 g/L or higher, haemoglobin greater than 100 g/L and lactose dehydrogenase (LDH) above the upper limit of normal were significantly associated with poorer EFS, with albumin and LDH also significantly linked to OS.

“The next question is how to further improve the care of patients with Burkitt's lymphoma, especially when the disease occurs in old patients with a high serum LDH concentration and a decreased haemoglobin or serum albumin concentration”, the team observes.

“The paediatric experience suggests that shortening of the duration of treatment of patients with [central nervous system] or [bone marrow] involvement might be an important option to explore without compromise of efficacy”, they write.

“Advances in the pathogenesis of Burkitt's lymphoma open new areas for clinical research.”


Ribrag V, Koscielny S, Bosq J, et al. Rituximab and dose-dense chemotherapy for adults with Burkitt’s lymphoma: a randomised, controlled, open-label phase 3 trial. Lancet 2016; Advance online publication 11 April. DOI: http://dx.doi.org/10.1016/S0140-6736(15)01317-3

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