Treatment of Burkitt's tumor with cyclophosphamide

Abstract

The results of therapy of 57 previously untreated patients with Burkitt's tumor seen over a 2‐year period at the Lymphoma Treatment Center, Kampala, Uganda are reported. Thirty‐seven patients were randomized to either a single dose or multiple doses of intravenous cyclophosphamide (CTX) 40 mg/kg. Ten of 11 patients with localized (stage I‐II) disease have continued in complete remission regardless of drug schedule. Among stage III patients, remission duration was shorter and relapse was more common in the group receiving a single dose. Intrathecal chemotherapy using methotrexate and cytosine arabinoside was successfully employed in the management of 12 patients with malignant cells in the cerebrospinal fluid. However, more aggressive and prolonged therapy is indicated to prevent relapse. Secondary chemotherapy using vincristine, methotrexate, and cytosine arabinoside produced complete responses in 90% of patients relapsing on multiple‐dose CTX. This study showed that: 1. single doses of CTX are capable of inducing long remissions in patients with localized disease; 2. multiple doses of CTX do not appear harmful in the maintenance of remissions in patients with localized tumors; 3. multiple doses of CTX result in fewer relapses and longer remissions in patients with visceral (stage III) disease compared with a single‐dose regimen; 4. the prognosis is improved in stage III patients who undergo surgical reduction of tumor bulk prior to chemotherapy; and 5. recognition and aggressive treatment of patients in relapse, particularly those with central nervous system involvement, are important considerations in the long term management of Burkitt's tumor. Copyright © 1970 American Cancer Society