High dose-intensive chemotherapy regimens have been shown as effective for children with Burkitt lymphoma. However, the intensity often leads to discomfort, adverse reactions, and poor outcomes in adult patients, particularly those with comorbidities or risk factors. Recently, shares MedScape, researchers sought to understand whether dose-adjusted chemotherapy (EPOCH-R) would result in better outcomes. They found that the new EPOCH-R was effective in treating patients without the additional toxicities. Read the full study findings in the Journal of Clinical Oncology.
EPOCH-R: The Study
What is EPOCH-R?
According to the National Cancer Institute, an EPOCH regimen is a type of chemotherapy treatment designed to treat aggressive forms of lymphoma. It consists of etoposide phosphate, prednisone, vincristine sulfate, cyclophosphamide, and doxorubicin hydrochloride.
In this new form, EPOCH-R, the drug combination consists of etoposide, doxorubicin, vincristine, prednisone, cyclophosphamide, and Rituximab.
Treating Patients with Burkitt Lymphoma
Researchers first ran a pilot study on EPOCH-R, in which 30 patients participated. Although the dose-adjusted treatment was effective, researchers wanted to reaffirm these results in a larger patient population. So, their next study followed 113 patients with Burkitt lymphoma over a period of 7 years. Information on the study includes:
- 49 years old: the median patient age
- 89 patients (79%) were male. 24 patients (21%) were female.
- 70 patients (62%) were 40 years old or older. 29 patients (26%) were 60 years old or older.
- Low risk vs. high risk: Patients were split into these categories, which determined their dosage of EPOCH-R.
- Low risk patients were given 2 cycles of EPOCH-R, with Rituximab on the 1st and 5th days. In some cases, patients received 1-4 additional treatment cycles.
- High risk patients were given 6 cycles of EPOCH-R, with Rituximab only on the 1st day. Patients also received prophylaxis or therapy.
- 15 patients (13%) were low risk. 98 patients (87%) were high risk.
- 28 patients (24.7%) had HIV.
The overall survival rate was 87%, with 84.5% being event-free. While 5 patients (4.4%) died of toxicity, most patients did not experience severe adverse reactions. Those that did experience adverse reactions had:
- Neutropenia: a low number of white blood cells
- Thrombocytopenia: a low platelet count
- Tumor lysis syndrome: when tumor cells break open and release into the bloodstream
However, patients who showed other central nervous system issues, such as problems with cerebrospinal fluid, had worse outcomes. Despite this, researchers believe that EPOCH-R is ultimately well-tolerated, cost-effective, and safe for patients with Burkitt lymphoma.
Burkitt lymphoma is a rare and highly aggressive form of non-Hodgkin lymphoma that comprises around 30% of all pediatric non-Hodgkin lymphoma cases. However, it rarely affects adults; only 1-2% of adult lymphoma cases are attributed to this form. Burkitt lymphoma forms in B-cells, a type of immune cell. Ultimately, it has 3 forms: endemic, sporadic, and immunodeficiency-related.
Symptoms vary based on type and bodily location, but may include:
- Abdominal swelling
- Painful and rapidly growing tumors in the abdominal and chest areas
- Night sweats
- Nausea and diarrhea
- Swollen lymph nodes
- Unexplained weight loss
Learn more about Burkitt lymphoma.