RD-CODOX-M/IVAC with rituximab and intrathecal liposomal cytarabine in adult Burkitt lymphoma and 'unclassifiable' highly aggressive B-cell lymphoma

Gaetano Corazzelli, Ferdinando Frigeri, Filippo Russo, Chiara Frairia, Manuela Arcamone, Gennaro Esposito, Annarosaria De Chiara, Emanuela Morelli, Gaetana Capobianco, Cristina Becchimanzi, Francesco Volzone, Mariangela Saggese, Giampaolo Marcacci, Rosaria De Filippi, Umberto Vitolo, Antonio Pinto

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Specific trials on adult Burkitt lymphoma (BL) and 'unclassifiable' lymphomas with features intermediate between BL and diffuse large B-cell lymphoma (BL/DLBCL) are advocated which include substantial numbers of older patients, to improve treatment feasibility, while countering risks of systemic and central nervous system (CNS) recurrences. We prospectively evaluated a modified CODOX-M/IVAC (CODOX-M: cyclophosphamide, vincristine, doxorubicin, high-dose methotrexate; IVAC: ifosfamide, etoposide and high-dose cytarabine) regimen by the addition of rituximab (R) and liposome-encapsulated cytarabine (D) to increase antitumour activity and halve the number of intrathecal treatments. Thirty adults (40% >60years) with BL (n=15) and BL/DLBCL (n=15) were accrued. Primary endpoints were progression-free survival (PFS), CNS recurrence, and liposomal cytarabine-associated toxicity. Eighty percent of patients received the whole treatment programme, the remaining cases received at least three full courses. Application of the RD-CODOX-M/IVAC regimen resulted in remarkable 4-year PFS (78%) and complete remission (CR) rates (93%). However, PFS was significantly lower in patients older than 60years as compared to younger ones (49%vs 93%, P=0·03; median, 36months), despite high actual dose-intensity, CR rate and tolerability. Reduced-intensity intratechal prophylaxis through liposomal cytarabine was effective because the CNS failure rate was low (3·4%) and without severe neurological toxicities. The RD-CODOX-M/IVAC strategy is feasible and highly effective, but improving outcomes in elderly patients remains a priority.

Original languageEnglish
Pages (from-to)234-244
Number of pages11
JournalBritish Journal of Haematology
Issue number2
Publication statusPublished - Jan 2012


  • Burkitt lymphoma
  • CNS prophylaxis
  • Liposomal cytarabine
  • Magrath regimen
  • Rituximab

ASJC Scopus subject areas

  • Hematology


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