A case report of acquired immunodeficiency syndrome (AIDS)-related refractory Burkitt lymphoma got complete remission by multidisciplinary and multi-target combined therapy

Abstract

Background: The incidence of Burkitt lymphoma among acquired immunodeficiency syndrome (AIDS) patients is significantly higher than that in general populations. It often features high malignancy and a poor prognosis. For patients with AIDS-related Burkitt lymphoma, the guidelines recommend the dose-adjusted EPOCH-R (DA-EPOCH-R) regimen (rituximab + etoposide vincristine + doxorubicin + cyclophosphamide + dexamethasone) as one of the first-line treatment options. If complete or partial responses are not achieved after first-line treatment, then a second-line regimen such as rituximab + gemcitabine + dexamethasone + cisplatin (R-GDP) or rituximab + ifosfamide + carboplatin + etoposide (R-ICE) can be employed instead. Patients without response to the second line regimen often have poor prognosis. However, with our growing understanding of the pathogenic mechanism of Burkitt lymphoma, it has become apparent that patients with Burkitt lymphoma who have a poor response to first- and second-line regimens require personalized treatment, such as immune checkpoint inhibitors [programmed death 1 (PD-1) inhibitors] or new small-molecule inhibitors [e.g., Bruton tyrosine kinase (BTK) inhibitors: ibrutinib and zanubrutinib; B-cell lymphoma-2 (BCL-2) inhibitors: venetoclax]. For the efficacy of the personalized treatment, the publication is scarce. Case Description: This report describes a patient with AIDS-related Burkitt lymphoma who did not achieve complete remission after first- and second-line treatment but eventually reached complete remission after combined therapy that included chemotherapy with small-molecule inhibitors, radiotherapy, and PD-1 inhibitors. During the multidisciplinary and multi-target combined therapy, patient has good tolerance. After 14 months' follow-up, patients' condition is stable. Conclusions: In addition to traditional chemotherapy and radiotherapy, the combined use of novel targeted therapies and early anti-HIV treatment maybe a choice to improve the prognosis of patients with AIDS-related refractory Burkitt lymphoma.