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Lymphoma, Burkitts

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Burkitt's lymphoma
Diffuse small noncleaved cell lymphoma

The hyperCVAD regimen (1)

8 courses of alternating chemotherapy.
Courses 1, 3, 5 and 7:
cyclosphosphamide 300 mg/m2 IV over 2 h, 12 hourly for 6 doses on days 1-3;
vincristine 2 mg IV on days 4 & 11;
doxorubicin 50 mg/m2 over 2 h on day 4
dexamethasone 40 mg/d on days 1-4 & 4-11.

Courses 2, 4, 6 and 8:
methotrexate 1 g/m2 IV over 24 h on day 1 with
leucovorin rescue starting 12 h after completion of the methotrexate
ara-C 3 g/m2 over 2 h q 12 h for four doses on days 2 and 3.

Dose adjustments for methotrexate and ara-C are recommended if creatinine is >132 micro mol/l. Inclusion criteria were age <60 years, performance status of 0-2 on the Zubrod scale, and normal renal and hepatic function prior to starting first course of chemotherapy. Cerebellar toxicity was graded as: grade 0 (absence of toxicity), grades 1-2 (mild-to-moderate impairment of cerebellar function), grade 3 [marked and prolonged (>3 d) dysfunction necessitating assistance in performing the activities of daily living, which was reversible], grade 4 [persistent (>1 month), irreversible or fatal grade 3 toxicity (Herzig et al, 1983)

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HyperCVAD (2):

5-day pre-phase of prednisolone 30 mg/m2 and cyclophosphamide 200 mg/m2,

followed by six cycles of chemotherapy, 3 weeks apart, alternating between schedules A and B.

Schedule A
Ifosfamide 800 mg/m2 on days 1-5,
vincristine 2 mg and
methotrexate 1.5 g/m2 on day 1,
etoposide 100 mg/m2 and cytosine 100 mg/m2 twice a day on days 4-5.

Schedule B
cyclophosphamide 200 mg/m2 on days 1-5,
vincristine 2 mg and
methotrexate 1.5 g/m2 on day 1 and
doxorubicin 25 mg/m2 on days 4-5.

In both schedules, dexamethasone was given orally from days 1 to 5.

CNS prophylaxis,
Triple intrathecal injections of methotrexate, cytosine and dexamethasone were given on days 1 and 5 of each schedule.

All patients receive a total of 6 courses of chemotherapy (3 of Schedule A & 3 of Schedule B) and 12 intrathecal injections of chemotherapy.
As prophylaxis against Pneumocystis carinii, all patients received nebulized pentamidine, monthly.