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Blood, 15 October 2007, Vol. 110, No. 8, pp. 2846-2854.
Prepublished online as a Blood First Edition Paper on July 3, 2007; DOI 10.1182/blood-2006-10-051771.


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Submitted October 17, 2006
Accepted June 15, 2007

Intensive chemotherapy regimen (LMB 86) for Saint Jude stage IV AIDS-related Burkitt lymphoma/leukemia: a prospective study

Lionel Galicier*, Claire Fieschi, Raphael Borie, Veronique Meignin, Marie-Therese Daniel, Laurence Gerard, and Eric Oksenhendler

Department of Clinical Immunology, Hopital St Louis, Assistance Publique-Hopitaux de Paris, Paris, France
Department of Pathology, Hopital St Louis, Assistance Publique-Hopitaux de Paris, Paris, France
Department of Cytology and Molecular Hematology, Hopital St Louis, Assistance Publique-Hopitaux de Paris, Paris, France

* Corresponding author; email: lionel.galicier{at}sls.aphp.fr.

Prognosis of AIDS-related non-Hodgkin lymphoma has improved since the introduction of highly active antiretroviral therapy. Burkitt lymphomas (BL) still have poor outcome in patients with bone marrow (BM) or central nervous system (CNS) involvement when treated with standard dose chemotherapy. We have prospectively evaluated the LMB86 regimen in 63 HIV infected patients with stage IV (BM and/or CNS involvement) BL consecutively recruited between November 1992 and January 2006. At BL diagnosis, the median CD4 cell count was 239 x106/L (range, 16-1188 x106/L). BM and CNS involvement were present in 55 (80%) and 48 (76%) patients, respectively. Forty-four patients (70%) achieved complete response. Seven treatment-related deaths occured and all patients experienced severe BM toxicity. With a median follow-up of 66 months (range, 6-165), 11 patients relapsed. The estimate two-year overall survival and disease-free survival were 47.1% (95% CI, 34-59.1) and 67.8% (95% CI, 51-80) respectively. We identified two poor prognosis factors: low CD4 count and ECOG>2. Patients with 0 or 1 factor had good outcome (two-year survival:60%) contrasting with patients with two factors (two-year survival:12%). We conclude that LMB86 regimen is highly effective in advanced HIV-related BL and should be proposed for patients with CD4 count >200 x106/L or ECOG≤2.


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