Small non-cleaved-cell lymphoma (undifferentiated lymphoma, Burkitt's type) in American adults: results with treatment designed for acute lymphoblastic leukemia

PURPOSE: Small non-cleaved-cer lymphoma (SNCL) 'Burkitt's type,' a rapidly growing lymphoma, has been rare among adults in the United States, but has greatly increased in incidence with the acquired immunodeficiency syndrome epidemic. This report details the results of treatment of adult SNCL with a series of protocols originally designed for the treatment of acute lymphoblastic leukemia ALL). PATIENTS AND METHODS: Between July 1973 and May 1987, 29 adults with newly diagnosed SNCL were treated at Memorial Hospital with intensive chemotherapy or designed for ALL, the cyclophosphamide L-2, L-10, L-17, and L-20 protocols. Nine patients had positive serologies for human immminodeficiency virus HIV) infection. One patient with all measurable disease resected was not evaluable for response. RESULTS: Sixteen of 28 evaluable patients (57%) achieved a complete remission with treatment. With follow-up as long as 153 months (median, 47 months), 50% of allpatients and 59% of patients with negative or uknown HIV serologies have survived and are probably cured. Patients with an initial serum lactic acid dehydrogenase (LDH) level of greater than 500 U/L had a significantly shortened survival as compared with those with a lower serum LDH Other pretreatment patient characteristics associated with a shortened survival of borderline statistical significance were high National Cancer Institute stage (C, D) and bone marrow involvement. These results are similar to those for all and lymphoblastic lymphoma and are comparable to those for American SNCL in the literature. CONCLUSIONS- Approximately one half of adults with SNCL are curable with intensive chemotherapy. More intensive chemotherapy with hematopoietic growth factor and/or autologous bone marrow or peripheral stem cell support may increase curability.
Small non-cleaved-cell lymphoma (SNCL), also referred to as Burkitt's type lymphoma, is a rapidly growing cancer of the lymphoid tissue which rarely occurs in adults in the United States. However, the incidence of SNCL among adults has increased with the AIDS epidemic. The effectiveness of a drug regimen used to treat acute lymphoblastic leukemia (ALL), another cancer of the blood, was assessed in 28 patients with SNCL. Nine patients had evidence of infection with the human immunodeficiency virus (HIV), which causes AIDS. The drug regimen designed for ALL consisted of the anticancer agent, cyclophosphamide, in the L-2, L-10, L-17, and L-20 protocols. Complete remission was achieved in 16 of 28 patients (57 percent). Fifty percent of all patients and 59 percent of patients with no known HIV disease had survived 47 months and were probably cured at the time of publication. A shorter duration of survival was associated with: levels of the enzyme, lactic acid dehydrogenase, that were greater than 500 units per liter; advanced stages of cancer; and involvement of the bone marrow. These findings show that intensive chemotherapy is effective in treating about 50 percent of patients with SNCL. Therapy that enhances bone marrow function, such as hematopoietic growth factor, may improve treatment of SNCL. (Consumer Summary produced by Reliance Medical Information, Inc.)