布基特淋巴瘤和白血病年轻成人免疫化疗剂量减少的可行性和疗效：BURKIMAB14试验结果.
Feasibility and outcomes after dose reduction of immunochemotherapy in young adults with Burkitt lymphoma and leukemia: results of the BURKIMAB14 trial.
发表日期：2023 Aug 10
作者：
Josep-Maria Ribera, Mireia Morgades, Olga Garcia-Calduch, Maialen Sirvent, Buenaventura Buendia, Marta Cervera, Hugo Luzardo, Jesus-Maria Hernandez-Rivas, Marta Sitges, Irene Garcia-Cadenas, Pau Abrisqueta, Pau Montesinos, Mariana Bastos-Oreiro, Maria-Paz Queipo De Llano, Pilar Bravo, Anna Torrent, Pilar Herrera, Antoni Garcia-Guinon, Ferran Vall-Llovera, Josefina Serrano, Maria-Jose Terol, Juan-Miguel Bergua, Ana Garcia-Noblejas, Cristina Barrenetxea, Laura Llorente, Daniel Garcia-Belmonte, Eva Gimeno, Antonia Cladera, Santiago Mercadal, Juan-Manuel Sancho
来源：
HAEMATOLOGICA
摘要：
不论是否感染人类免疫缺陷病毒（HIV），高剂量密集治疗或渗注中剂量免疫化疗均是布基特淋巴瘤（BL）的高效治疗。然而，尤其是对于老年患者而言，这些方案的毒副作用显得尤为相关。前瞻性多中心BURKIMAB14试验根据分期（局部：I和II非肿块型；晚期：II肿块型，III，IV）和年龄，包括4-6个免疫化疗模块，年龄超过55岁的患者减药。在年龄≤55岁的患者中，化疗强度在达到完全代谢反应（CMR）后降低，将其结果与前一项BURKIMAB08试验中类似患者的结果进行比较，而在该试验中未进行剂量减少。在86/107（80%）患者中获得了CMR（局部分期17/19，晚期分期69/88）。BURKIMAB14试验中年龄≤55岁的患者显示出类似的总生存（OS）率，以及较少的感染和细胞减少症，与BURKIMAB08试验中的患者相比。即使在化疗剂量减少的情况下，>55岁的患者的与治疗相关的死亡率明显更高。在3.61年的中位随访时间内，4年总生存（OS）概率为73%（63%-81%）。年龄（≤55岁与>55岁）和分期（局部与晚期）具有预后意义。HIV阳性与阴性患者的总生存没有显著差异。BURKIMAB14的结果与其他高剂量密集免疫化疗试验相似。>55岁和晚期分期，而不是HIV感染，与生存率差相关。青年患者在CMR时化疗剂量减小是安全的，并不影响结果。
High dose-intensive or infusional intermediate-dose immunochemotherapy is highly effective treatment for Burkitt lymphoma (BL) irrespective of human immunodeficiency virus (HIV) infection. However, toxicities of these regimens are relevant, especially in older adults and elderly patients. The prospective multicenter BURKIMAB14 trial included 4-6 blocks of immunochemotherapy according to stage (localized: I and II non-bulky; advanced: II bulky, III, IV) and age, with dose reduction in patients >55 yrs. Dose-intensity of chemotherapy was reduced in patients ≤55 yrs. after achieving complete metabolic response (CMR), and their outcomes were compared with those of similar patients included in the former BURKIMAB08 trial, in which there was no dose reduction. CMR was attained in 86/107 (80%) patients (17/19 in localized stages and 69/88 in advanced stages). Patients from the BURKIMAB14 trial ≤55 yrs. showed a similar OS and fewer infections and cytopenias than patients from the BURKIMAB08 trial. Patients >55yrs. had a significantly higher treatment-related mortality despite dose reduction of chemotherapy. With a median follow-up of 3.61 yrs. the 4-yr. overall survival (OS) probability was 73% (63%-81%). Age (≤55 yrs. vs. >55 yrs.) and stage (localized vs. advanced) had prognostic significance. No significant differences in OS were observed in HIV-positive vs. -negative patients. The results of BURKIMAB14 are similar to those of other dose-intensive immunochemotherapy trials. Age >55 yrs. and advanced stage, but not HIV infection, were associated with poor survival. Dose reduction of chemotherapy in young adults in CMR is safe and does not impact outcomes.