ABCL-400 adult Burkitt lymphoma: An institutional experience with uniform DA-EPOCH-R protocol

Abstract

Context: DA-EPOCH-R (dose-adjusted etoposide, doxorubicin, cyclophosphamide, vincristine, prednisolone, and rituximab) is one of the standard chemotherapeutic regimens for Burkitt lymphoma. Objective: This study aimed to evaluate the safety and efficacy of DA-EPOCH-R in adult Burkitt lymphoma in an Indian context. Design, Setting, and Participants: This retrospective study included 16 patients with adult Burkitt lymphoma who received uniform DA-EPOCH-R protocol, intrathecal methotrexate with each cycle, and GCSF prophylaxis in the Department of Medical Oncology at All India Institute of Medical Sciences, New Delhi, India, from May 1, 2013, to December 2021. Results: Sixteen patients were included in this study. The median age was 35 (21–65) years with a male:female ratio of 3:1. The stage distribution was I/II in 4 cases (25%) and III/IV in 12 cases (75%). Poor performance status (ECOG>2) was observed in 9 cases (56.25%). One case was HIV-positive, and 13 cases (81.2%) were high risk. CSF cytology was negative in all cases at baseline, and 5 cases had bone marrow involvement. Low albumin (serum albumin <3.5 g/dL) was seen in 6/16 cases (37.5%). After the median 5 cycles (range 3–6) of chemotherapy, the overall response was 93.7%, and 81.25% of patients achieved complete response. The maximum dose intensity was level 3 in 6 patients, level 2 in 9 patients, and level 1 in 1 patient. There were no treatment-related deaths. The most common hematological toxicities (grade 3–4) were neutropenia in 3 patients, thrombocytopenia in 1 patient, and anemia in 2 patients. Febrile neutropenia was observed in 2 patients. Infections, thrombosis, and Grade 3 peripheral neuropathy were documented in 4, 2, and 1 cases, respectively. In our study, 2-year event-free survival and overall survival were 75.4% and 83%, respectively, with a median follow-up period of 27 months. Conclusions: DA-EPOCH-R is an effective and safe protocol even in high-risk adult Burkitt lymphoma patients.