Initial treatment of very aggressive lymphomas

Non-endemic Burkitt lymphoma: successful treatment of BL in children has informed adult treatment. High remission rates and long-term DFS achieved with intensive short duration (3-6 months) multi-agent chemotherapy regimens including high dose methotrexate, high dose cytarabine, etoposide, ifosfamide and CNS prophylaxis. Protocols designed for lymphoblastic lymphoma or ALL clearly inferior to specific BL protocols. 90% EFS rates in childhood BL. Treatment of adults with BL with intensive regimens including intrathecal therapy such as CODOX-M/IVAC (Vincristine, doxorubicin, cyclophosphamide, methotrexate, folinic acid, G-CSF plus IT cytarabine and IT methotrexate/etoposide, ifosfamide, mesna, cytarabine, folinic acid, G-CSF plus IT methotrexate) improves response and survival rates (~50% curable) though not to childhood results. The role of high dose therapy is uncertain. Meningeal involvement still carries poor prognosis.

Lymphoblastic lymphoma:management in adults has also followed more successful intensive regimens in childhood based on ALL treatment

(including CNS prophylaxis). High CR rates (~85%) and 5 year DFS up to 45% reported. The poor outlook for patients has led to evaluation of high-dose therapy with autologous or allogeneic BMT early in its management.

Adult T-leukaemia/lymphoma: £BpJ8S.

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