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Treatment Outcome of Burkitt's Lymphoma in Adolescents and Adults: A Retrospective Study
CC BY 4.0 · Indian J Med Paediatr Oncol 2024; 45(01): 022-027
DOI: OI: 10.1055/s-0043-1768177
Abstract
Introduction Burkitt's lymphoma (BL) is a highly aggressive B cell non-Hodgkin lymphoma (NHL) having three distinct subtypes: endemic, sporadic, and immunodeficiency-associated BL. Sporadic BL accounts for only 1 to 2% of adult NHL.
Objectives The objective of this article was to study the clinical profile and treatment outcome of patients with BL.
Materials and Methods This was a retrospective study of 60 patients with BL conducted in the department of medical oncology at a tertiary cancer center in India during a 10-year period. Patients with BL/leukemia above 14 years of age diagnosed during the study period were included and their clinical presentation, treatment details, and outcome were studied.
Results Among 60 cases with BL, there were 41 males and 19 females. The median age at presentation was 42 years (range: 14–81 years). The main symptoms were lymphadenopathy, abdominal pain, and abdominal distension. Two patients each had paraparesis, breast lump, and jaw swelling and one patient had involvement of the cervix. Thirteen patients had features of tumor lysis at presentation. The Ann Arbor stage was I in 17, II in 16, III in 5, and IV in 22. Fifty-five patients received combination chemotherapy that included hyper-cyclophosphamide, vincristine, adriamycin, dexamethasone ± rituximab (hyper-CVAD ± R; 35), cyclophosphamide, adriamycin, vincristine, prednisolone/ cyclophosphamide, vincristine, prednisolone ± rituximab CHOP ± R (13), Berlin-Frankfurt-Munich protocol (4), and others (3). Thirty-four patients attained remission, 13 patients had progressive disease, and 8 patients died during chemotherapy. At a median follow-up of 113 months, 58% patients were alive.
Conclusions BL accounts for 1.57% of NHL above the age of 14 years with male preponderance. Intensive, short-duration chemotherapy is the standard treatment. Treatment with hyper-CVAD ± R gives 8-year progression-free survival and overall survival (OS) of 60%. Treatment with CHOP ± R is an alternative option in elderly frail patients with an 8-year OS of 46%.
Keywords
Burkitt's lymphoma - non-Hodgkin lymphoma - clinical characteristics - treatment outcomeAuthors' Contributions
S.M.T. was involved in design, literature search, data acquisition, data analysis, statistical analysis, and manuscript preparation. G.N. contributed to conceptualization, designing, data acquisition, data analysis, manuscript preparation, manuscript editing, and manuscript review. A.T.M. helped in data acquisition and manuscript editing. S.G.N., P.N.P., and R.A.N. contributed to data acquisition. Jagathnath Krishna did statistical analysis.
Supplementary MaterialPublication History
Article published online:
24 April 2023
© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India
Abstract
Introduction Burkitt's lymphoma (BL) is a highly aggressive B cell non-Hodgkin lymphoma (NHL) having three distinct subtypes: endemic, sporadic, and immunodeficiency-associated BL. Sporadic BL accounts for only 1 to 2%-of adult NHL.
Objectives The objective of this article was to study the clinical profile and treatment outcome of patients with BL.
Materials and Methods This was a retrospective study of 60 patients with BL conducted in the department of medical oncology at a tertiary cancer center in India during a 10-year period. Patients with BL/leukemia above 14 years of age diagnosed during the study period were included and their clinical presentation, treatment details, and outcome were studied.
Results Among 60 cases with BL, there were 41 males and 19 females. The median age at presentation was 42 years (range: 14–81 years). The main symptoms were lymphadenopathy, abdominal pain, and abdominal distension. Two patients each had paraparesis, breast lump, and jaw swelling and one patient had involvement of the cervix. Thirteen patients had features of tumor lysis at presentation. The Ann Arbor stage was I in 17, II in 16, III in 5, and IV in 22. Fifty-five patients received combination chemotherapy that included hyper-cyclophosphamide, vincristine, adriamycin, dexamethasone ± rituximab (hyper-CVAD ± R; 35), cyclophosphamide, adriamycin, vincristine, prednisolone/ cyclophosphamide, vincristine, prednisolone ± rituximab CHOP ± R (13), Berlin-Frankfurt-Munich protocol (4), and others (3). Thirty-four patients attained remission, 13 patients had progressive disease, and 8 patients died during chemotherapy. At a median follow-up of 113 months, 58% -patients were alive.
Conclusions BL accounts for 1.57%-of NHL above the age of 14 years with male preponderance. Intensive, short-duration chemotherapy is the standard treatment. Treatment with hyper-CVAD ± R gives 8-year progression-free survival and overall survival (OS) of 60%. Treatment with CHOP ± R is an alternative option in elderly frail patients with an 8-year OS of 46%.
eywords
Burkitt's lymphoma - non-Hodgkin lymphoma - clinical characteristics - treatment outcomeIntroduction
Burkitt's lymphoma (BL) is an aggressive B-cell lymphoma characterized by a high degree of proliferation of the malignant cells and deregulation of the proto-oncogene c-myc.[1] BL is predominantly a disease of childhood, but it is also seen in the adult population. The World Health Organization (WHO) classification of BL describes three clinical variants: endemic, sporadic, and immunodeficiency-related.[2] These types are similar in morphology, immunophenotype, and genetic features. Endemic BL is the most common childhood cancer in equatorial Africa associated with Epstein–Barr virus (EBV) and plasmodium falciparum malaria. The sporadic type predominates in the rest of the world with no special climatic or geographical links, and is rarely associated with EBV infection. Sporadic BL (sBL), accounts for 1 to 2%-of all adult lymphomas in Western Europe and the United States.[3] The diagnostic and therapeutic principles of BL in adults are the same as those in the pediatric population. A recent study of the Swedish Lymphoma Registry confirmed advanced age, poor WHO performance status, and elevated serum lactate dehydrogenase (LDH) as significant prognostic factors for adult BL.[4]
The present retrospective analysis provides information on clinical presentation, histology patterns, and outcome of adolescents, adults, and elderly patients with BL treated at a tertiary cancer center in India.
Objectives
The objectives of this article were to study the clinical characteristics, treatment response, and survival of BL in adolescent and adult patients. The primary outcome measures were treatment response and progression-free survival (PFS). The secondary outcome measure was overall survival (OS) at 8 years.
Materials and Methods
Study Setting: This was a retrospective study conducted in the department of medical oncology at a tertiary cancer center in India during a 10-year period (January 2005 to December 2014). Patients with BL/leukemia above 14 years of age treated during the study period were included. We analyzed 60 patients with BL.
Inclusion/ Exclusion Criteria: Eligibility criteria included all patients aged above 14 years with a histological diagnosis of BL/leukemia. Patients with relapsed BL and who received some prior treatments were excluded from the study.
Methodology: Medical records of patients were studied with respect to the demographic details, clinical history, physical examination, baseline investigations like complete hemogram, serum chemistry, and serum LDH. Staging workup including histopathology report, bone marrow study, cerebrospinal fluid analysis, and imaging studies were noted. The disease was staged according to the Ann Arbor staging system. The treatment response at the end of induction and on completion of treatment was obtained. Clinical response was classified as complete remission (CR), partial remission (PR), stable disease (SD), and progressive disease based on modified Cheson lymphoma response evaluation criteria.[5] OS was assessed from the initiation of definitive chemotherapy to the last follow-up or death and PFS was calculated from the initiation of chemotherapy till disease progression.
Statistical Analysis: The baseline patient characteristics, treatment details, and response assessment were analyzed using descriptive statistics. OS and PFS were obtained by Kaplan–Meier method, using SPSS v. 11. The risk analysis for OS and PFS was done using Cox regression analysis. Statistical significance was defined as a p-value less than 0.05.
Ethics: The study was approved by the Institutional Review Board (IRB No. 09/2016/03, dated September 1, 2016). Informed consent was waived off due to retrospective nature of the study. All procedures performed in study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
|
Baseline patient characteristics (n = 60) |
Frequency, n (%) |
|---|---|
|
Median age (years) |
42 (range: 14–81) |
|
M: F ratio |
2.16: 1 |
|
B symptoms |
39 (65) |
|
Hb < 10 g/ dL |
15 (25) |
|
Platelet count < 1 class="alt">3 |
06 (10) |
|
Elevated LDH |
44 (73) |
|
Biochemical TLS (S.UA≥8mg/dL, S. K≥6mEq/L, S. Ph≥4.6mg/dL, S. Ca ≤ 7mg/dL) |
13 (22) |
|
Hypoalbuminemia (S. albumin < 3.5 g/dL) |
13 (22) |
|
Renal impairment (S. Cr > 1.5 of ULN) |
06 (10) |
|
Hepatic impairment (S. Bil > 2 times of ULN) |
7 (12) |
|
Stage I II III IV |
17 (28) 16 (27) 05 (8) 22(37) |
|
Burkitt's leukemia (bone marrow blast > 20%) |
11(18) |
|
Treatment outcome |
HCVAD ± R |
CHOP/CVP ± R |
BFM |
R CODOX M-IVAC |
Murphy's protocol |
|---|---|---|---|---|---|
|
Total no. |
35 |
13 |
4 |
1 |
2 |
|
Complete remission |
22 (63%) |
6 (47%) |
3 (75%) |
1 (100%) |
2 (100%) |
|
Progressive disease |
9 (26%) |
3 (23%) |
1 (25%) |
Nil |
Nil |
|
Death |
4 (11%) |
4 (30%) |
Nil |
Nil |
Nil |
|
Relapse |
2 (6%) |
NIL |
1 (25%) |
Nil |
1 (50%) |
|
8-year OS |
60%. |
46.2%. |
50%. |
100%. |
50%. |
|
Variables |
8-year PFS (%) |
8-year OS (%) |
||||
|---|---|---|---|---|---|---|
|
% |
SE |
p-Value |
% |
SE % |
p-Value |
|
|
Age (years) < 40> 40–65 > 65 |
80.0 41.2 16.7 |
8.0 10.1 15.2 |
0.001 |
80.0 45.8 16.7 |
8.0 10.2 15.2 |
0.001 |
|
Sex Male Female |
52.5 66.0 |
7.9 12.4 |
0.301 |
55.0 66.7 |
7.9 12.2 |
0.299 |
|
LDH < 2000 ≥ 2000 |
58.3 69.2 |
8.2 12.8 |
0.573 |
61.1 69.2 |
8.1 12.8 |
0.558 |
|
Burkitt's lymphoma Burkitt's leukemia |
56.8 54.5 |
7.5 15.0 |
0.885 |
59.1 54.5 |
7.4 15.0 |
0.87 |
|
Stage 1 2 3 4 |
56.3 42.9 100 58.7 |
12.4 13.2 - 10.6 |
0.425 |
62.5 42.9 100 59.1 |
12.1 13.2 - 10.5 |
0.430 |
|
Chemo CHOP ± R HCVAD ± R |
36.9 60.0 |
13.8 8.3 |
0.123 |
46.2 60.0 |
13.8 8.3 |
0.125 |
| Fig 1 : Survival Chart Showing Progression Free Survival (PFS) and Overall Survival (OS) at 8 years.
Discussion
BL is one of the most aggressive types of cancer and yet one of the most curable. Mostly, BL originates from B cells in the follicular germinal center. BL is the first lymphoma reported to be associated with HIV infection.[6] sBL in North America and Europe makes up 30 to 40%-of childhood NHL and 1 to 5%-of adult NHL.[7] sBL attacks regions outside Africa, with an incidence of about 4 per million in the United States.[8] In India, BL constitutes 1.8 to 3.4%-of all adult NHL.[9] BL is a classic example of a human malignancy whose pathogenesis involves a specific cellular genetic change characterized by a chromosomal translocation deregulating expression of the c-myc oncogene, complemented in many cases by the action the EBV.[10]
This is the largest case series from India describing the treatment outcome of adolescent and adult patients with BL. In our series, the median age at presentation was 42 years (range: 14–81 years) with 11%-patients above 65 years of age. These findings are consistent with other case series.[3] [11] [12] In an Indian study including pediatric patients, BL constituted 3.5%-of all NHL and the median age at presentation was 22 years.[13] In this study, patients have a higher frequency of B-symptoms (65%) and advanced disease compared to European studies.[14] In our study, bone marrow involvement was the most common extranodal site (30%) followed by gastrointestinal tract (22%). CNS involvement in our study was 3%-compared to 15%-in a study by Saleh et al.[14] Eleven patients (18%) had BL at presentation that was comparable with another study by Mbulaiteye et al.[7]
Treatment success of BL resulted from the introduction of dose-intense multidrug chemotherapy, prophylaxis of CNS disease, and improvements in supportive care. The management of this aggressive lymphoma is a challenge in our resource-limited setting and the published data from the Indian population is scarce. The frequently used regimens in adolescent and adults based on pediatric protocols are CODOX-M/IVAC, the German BFM, and the French Lymphome Malins B regimens. Other regimens used for adult BL include the HCVAD, the Cancer and Leukemia Group B regimen, and the dose-adjusted EPOCH.[15] [16] [17] In our study, most of the young and fit patients received HCVAD ± R (63.5%) and elderly patients with poor performance status received CHOP/CVP ± R (22%). The complete response rate in the entire population was 62%, 2-year PFS of 58.3%, and a 2-year OS of 61.6%. A study from India showed similar results with a complete response rate of 63%-with 2-year PFS of 56%.[18] Patients above 65 years of age and frail patient who received less intense therapy, the 8-year OS was 46%-that makes it an alternate option in elderly and frail patients. Similar studies in BL in adult patients receiving CHOP-based chemotherapy had a 2-year OS of 33 to 39%.[19] [20] Patients who received HCVAD ± R chemotherapy had a complete response rate of 63%, 8-year PFS and OS of 60%. Review on treatment outcome in BL is given in [Table 4].[12] [17] [21] [22] [23] [24] [25] In this study, only a few patients received other chemotherapy regimens like CODOX-M/IVAC, BFM, and Murphy's protocol to compare on survival. [Table 4] shows review of treatment outcome in BL.
|
Reference |
Regimen |
n |
Median age (years) |
EFS/PFS |
OS |
|---|---|---|---|---|---|
|
Thomas et al[21] |
Hyper-CVAD |
26 |
58 |
3-year CCR 61% |
3-year OS 49% |
|
Thomas et al[17] |
R-hyper CVAD |
31 |
46 |
3-year EFS 80% |
3-year OS 89% |
|
Mead et al[12] |
CODOX-M/IVAC |
53 |
37 |
2-year EFS 64% |
2-year OS 67% |
|
Magrath et al[22] |
CODOX-M/IVAC |
41 |
25 |
2-year PFS 92% |
NA |
|
Lacasce et al[23] |
CODOX-M/IVAC |
14 |
47 |
2-year PFS 92% |
NA |
|
Patekar et al[24] |
CODOX-M/IVAC |
18 |
38 |
1-year PFS 76% |
1-year OS 81.1% |
|
Rizzieri et al[25] |
CALGB regimen |
105 |
44 |
2-year EFS 74% |
3-year OS 58% |
|
Present study |
Hyper-CVAD ± R |
35 |
43 |
8-year PFS 56.3% |
8-year OS 60% |
References
- Jaffe ES, Harris NL, Stein H, Vardiman JW. . Tumours of Haematopoietic and Lymphoid Tissues. Lyon, France: IARC Press; 2001
- Jaffe ES. The 2008 WHO classification of lymphomas: implications for clinical practice and translational research. Hematology (Am Soc Hematol Educ Program) 2009; 1: 523-531
- Boerma EG, van Imhoff GW, Appel IM, Veeger NJ, Kluin PM, Kluin-Nelemans JC. Gender and age-related differences in Burkitt lymphoma--epidemiological and clinical data from The Netherlands. Eur J Cancer 2004; 40 (18) 2781-2787
- Wästerlid T, Jonsson B, Hagberg H, Jerkeman M. Population based study of prognostic factors and treatment in adult Burkitt lymphoma: a Swedish Lymphoma Registry study. Leuk Lymphoma 2011; 52 (11) 2090-2096
- Cheson BD, Pfistner B, Juweid ME. et al; International Harmonization Project on Lymphoma. Revised response criteria for malignant lymphoma. J Clin Oncol 2007; 25 (05) 579-586
- Schulz TF, Boshoff CH, Weiss RA. HIV infection and neoplasia. Lancet 1996; 348 (9027): 587-591
- Mbulaiteye SM, Biggar RJ, Bhatia K, Linet MS, Devesa SS. Sporadic childhood Burkitt lymphoma incidence in the United States during 1992-2005. Pediatr Blood Cancer 2009; 53 (03) 366-370
- Teras LR, DeSantis CE, Cerhan JR, Morton LM, Jemal A, Flowers CR. 2016 US lymphoid malignancy statistics by World Health Organization subtypes. CA Cancer J Clin 2016; 66 (06) 443-459
- Nair R, Arora N, Mallath MK. Epidemiology of non-Hodgkin's lymphoma in India. Oncology 2016; 91 (1, Suppl 1): 18-25
- Kelly GL, Rickinson AB. Burkitt lymphoma: revisiting the pathogenesis of a virus-associated malignancy. Hematology (Am Soc Hematol Educ Program) 2007; 1: 277-284 PubMed
- Mead GM, Sydes MR, Walewski J. et al; UKLG LY06 collaborators. An international evaluation of CODOX-M and CODOX-M alternating with IVAC in adult Burkitt's lymphoma: results of United Kingdom Lymphoma Group LY06 study. Ann Oncol 2002; 13 (08) 1264-1274
- Mead GM, Barrans SL, Qian W. et al; UK National Cancer Research Institute Lymphoma Clinical Studies Group; Australasian Leukaemia and Lymphoma Group. A prospective clinicopathologic study of dose-modified CODOX-M/IVAC in patients with sporadic Burkitt lymphoma defined using cytogenetic and immunophenotypic criteria (MRC/NCRI LY10 trial). Blood 2008; 112 (06) 2248-2260
- Arora N, Manipadam MT, Nair S. Frequency and distribution of lymphoma types in a tertiary care hospital in South India: analysis of 5115 cases using the World Health Organization 2008 classification and comparison with world literature. Leuk Lymphoma 2013; 54 (05) 1004-1011
- Saleh K, Michot JM, Camara-Clayette V, Vassetsky Y, Ribrag V. Burkitt and Burkitt-Like lymphomas: a systematic review. Curr Oncol Rep 2020; 22 (04) 33
- ;Lee EJ, Petroni GR, Schiffer CA. et al. Brief-duration high-intensity chemotherapy for patients with small noncleaved-cell lymphoma or FAB L3 acute lymphocytic leukemia: results of cancer and leukemia group B study 9251. J Clin Oncol 2001; 19 (20) 4014-4022
- Wilson WH, Grossbard ML, Pittaluga S. et al. Dose-adjusted EPOCH chemotherapy for untreated large B-cell lymphomas: a pharmacodynamic approach with high efficacy. Blood 2002; 99 (08) 2685-2693
- Thomas DA, Faderl S, O'Brien S. et al. Chemoimmunotherapy with hyper-CVAD plus rituximab for the treatment of adult Burkitt and Burkitt-type lymphoma or acute lymphoblastic leukemia. Cancer 2006; 106 (07) 1569-1580
- Sengar M, Akhade A, Nair R. et al. A retrospective audit of clinicopathological attributes and treatment outcomes of adolescent and young adult non-Hodgkin lymphomas from a tertiary care center. Indian J Med Paediatr Oncol 2011; 32 (04) 197-203
- Wästerlid T, Brown PN, Hagberg O. et al. Impact of chemotherapy regimen and rituximab in adult Burkitt lymphoma: a retrospective population-based study from the Nordic Lymphoma Group. Ann Oncol 2013; 24 (07) 1879-1886
- Longo DL, Duffey PL, Jaffe ES. et al. Diffuse small noncleaved-cell, non-Burkitt's lymphoma in adults: a high-grade lymphoma responsive to ProMACE-based combination chemotherapy. J Clin Oncol 1994; 12 (10) 2153-2159
- Thomas DA, Cortes J, O'Brien S. et al. Hyper-CVAD program in Burkitt's-type adult acute lymphoblastic leukemia. J Clin Oncol 1999; 17 (08) 2461-2470
- Magrath I, Adde M, Shad A. et al. Adults and children with small non-cleaved-cell lymphoma have a similar excellent outcome when treated with the same chemotherapy regimen. J Clin Oncol 1996; 14 (03) 925-934
- Lacasce A, Howard O, Lib S. et al. Modified Magrath regimens for adults with Burkitt and Burkitt-like lymphomas: preserved efficacy with decreased toxicity. Leuk Lymphoma 2004; 45 (04) 761-767
- Patekar M, Gogia A, Tiwari A. et al. Adult Burkitt lymphoma: an institutional experience with a uniform chemotherapy protocol. South Asian J Cancer 2018; 7 (03) 195-199
- Rizzieri DA, Johnson JL, Byrd JC. et al; Alliance for Clinical Trials In Oncology (ACTION). Improved efficacy using rituximab and brief duration, high intensity chemotherapy with filgrastim support for Burkitt or aggressive lymphomas: cancer and Leukemia Group B study 10 002. Br J Haematol 2014; 165 (01) 102-111
Address for correspondence
Geetha Narayanan, MD, DNB, DMProfessor & Head, Department of Medical Oncology, Regional Cancer CentreTrivandrum 695011, KeralaIndiaEmail: geenarayanan@yahoo.comPublication History
Article published online:
24 April 2023© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India
| Fig 1 : Survival Chart Showing Progression Free Survival (PFS) and Overall Survival (OS) at 8 years.
References
- Jaffe ES, Harris NL, Stein H, Vardiman JW. . Tumours of Haematopoietic and Lymphoid Tissues. Lyon, France: IARC Press; 2001
- Jaffe ES. The 2008 WHO classification of lymphomas: implications for clinical practice and translational research. Hematology (Am Soc Hematol Educ Program) 2009; 1: 523-531
- Boerma EG, van Imhoff GW, Appel IM, Veeger NJ, Kluin PM, Kluin-Nelemans JC. Gender and age-related differences in Burkitt lymphoma--epidemiological and clinical data from The Netherlands. Eur J Cancer 2004; 40 (18) 2781-2787
- Wästerlid T, Jonsson B, Hagberg H, Jerkeman M. Population based study of prognostic factors and treatment in adult Burkitt lymphoma: a Swedish Lymphoma Registry study. Leuk Lymphoma 2011; 52 (11) 2090-2096
- Cheson BD, Pfistner B, Juweid ME. et al; International Harmonization Project on Lymphoma. Revised response criteria for malignant lymphoma. J Clin Oncol 2007; 25 (05) 579-586
- Schulz TF, Boshoff CH, Weiss RA. HIV infection and neoplasia. Lancet 1996; 348 (9027): 587-591
- Mbulaiteye SM, Biggar RJ, Bhatia K, Linet MS, Devesa SS. Sporadic childhood Burkitt lymphoma incidence in the United States during 1992-2005. Pediatr Blood Cancer 2009; 53 (03) 366-370
- Teras LR, DeSantis CE, Cerhan JR, Morton LM, Jemal A, Flowers CR. 2016 US lymphoid malignancy statistics by World Health Organization subtypes. CA Cancer J Clin 2016; 66 (06) 443-459
- Nair R, Arora N, Mallath MK. Epidemiology of non-Hodgkin's lymphoma in India. Oncology 2016; 91 (1, Suppl 1): 18-25
- Kelly GL, Rickinson AB. Burkitt lymphoma: revisiting the pathogenesis of a virus-associated malignancy. Hematology (Am Soc Hematol Educ Program) 2007; 1: 277-284 PubMed
- Mead GM, Sydes MR, Walewski J. et al; UKLG LY06 collaborators. An international evaluation of CODOX-M and CODOX-M alternating with IVAC in adult Burkitt's lymphoma: results of United Kingdom Lymphoma Group LY06 study. Ann Oncol 2002; 13 (08) 1264-1274
- Mead GM, Barrans SL, Qian W. et al; UK National Cancer Research Institute Lymphoma Clinical Studies Group; Australasian Leukaemia and Lymphoma Group. A prospective clinicopathologic study of dose-modified CODOX-M/IVAC in patients with sporadic Burkitt lymphoma defined using cytogenetic and immunophenotypic criteria (MRC/NCRI LY10 trial). Blood 2008; 112 (06) 2248-2260
- Arora N, Manipadam MT, Nair S. Frequency and distribution of lymphoma types in a tertiary care hospital in South India: analysis of 5115 cases using the World Health Organization 2008 classification and comparison with world literature. Leuk Lymphoma 2013; 54 (05) 1004-1011
- Saleh K, Michot JM, Camara-Clayette V, Vassetsky Y, Ribrag V. Burkitt and Burkitt-Like lymphomas: a systematic review. Curr Oncol Rep 2020; 22 (04) 33
- ;Lee EJ, Petroni GR, Schiffer CA. et al. Brief-duration high-intensity chemotherapy for patients with small noncleaved-cell lymphoma or FAB L3 acute lymphocytic leukemia: results of cancer and leukemia group B study 9251. J Clin Oncol 2001; 19 (20) 4014-4022
- Wilson WH, Grossbard ML, Pittaluga S. et al. Dose-adjusted EPOCH chemotherapy for untreated large B-cell lymphomas: a pharmacodynamic approach with high efficacy. Blood 2002; 99 (08) 2685-2693
- Thomas DA, Faderl S, O'Brien S. et al. Chemoimmunotherapy with hyper-CVAD plus rituximab for the treatment of adult Burkitt and Burkitt-type lymphoma or acute lymphoblastic leukemia. Cancer 2006; 106 (07) 1569-1580
- Sengar M, Akhade A, Nair R. et al. A retrospective audit of clinicopathological attributes and treatment outcomes of adolescent and young adult non-Hodgkin lymphomas from a tertiary care center. Indian J Med Paediatr Oncol 2011; 32 (04) 197-203
- Wästerlid T, Brown PN, Hagberg O. et al. Impact of chemotherapy regimen and rituximab in adult Burkitt lymphoma: a retrospective population-based study from the Nordic Lymphoma Group. Ann Oncol 2013; 24 (07) 1879-1886
- Longo DL, Duffey PL, Jaffe ES. et al. Diffuse small noncleaved-cell, non-Burkitt's lymphoma in adults: a high-grade lymphoma responsive to ProMACE-based combination chemotherapy. J Clin Oncol 1994; 12 (10) 2153-2159
- Thomas DA, Cortes J, O'Brien S. et al. Hyper-CVAD program in Burkitt's-type adult acute lymphoblastic leukemia. J Clin Oncol 1999; 17 (08) 2461-2470
- Magrath I, Adde M, Shad A. et al. Adults and children with small non-cleaved-cell lymphoma have a similar excellent outcome when treated with the same chemotherapy regimen. J Clin Oncol 1996; 14 (03) 925-934
- Lacasce A, Howard O, Lib S. et al. Modified Magrath regimens for adults with Burkitt and Burkitt-like lymphomas: preserved efficacy with decreased toxicity. Leuk Lymphoma 2004; 45 (04) 761-767
- Patekar M, Gogia A, Tiwari A. et al. Adult Burkitt lymphoma: an institutional experience with a uniform chemotherapy protocol. South Asian J Cancer 2018; 7 (03) 195-199
- Rizzieri DA, Johnson JL, Byrd JC. et al; Alliance for Clinical Trials In Oncology (ACTION). Improved efficacy using rituximab and brief duration, high intensity chemotherapy with filgrastim support for Burkitt or aggressive lymphomas: cancer and Leukemia Group B study 10 002. Br J Haematol 2014; 165 (01) 102-111