Chemotherapy treatments for Burkitt lymphoma: systematic review of interventional studies

Abstract Background : Burkitt lymphoma (BL) is an aggressive hematological cancer. This study synthetized the evidence about the efficacy and safety of chemotherapy treatments used in patients diagnosed with BL using the World Health Organization classification . Materials and Methods : A systematic review of interventional studies was performed. A search was carried out in PubMed, Scopus, and Web of Science, with additional manual and gray literature searches. The methodological quality of articles was assessed with the Newcastle-Ottawa scale . Results : Initially, 1,358 studies were identified, with nine (all non-randomized) satisfying the eligibility criteria (n=544 patients). The BL epidemiological variants were sporadic BL (sBL) (44.5%), endemic BL (eBL) (47.2%), and immunodeficiency-associated BL (iBL) (8.3%). Regarding chemotherapy protocols, four groups were identified: based on CODOX-M/IVAC (n=4), EPOCH (n=1), BFM (n=1), and simplified treatment schemes used in African countries (n=3). Most studies had a moderate quality. Empirically and qualitatively, the best options for adults with sBL were ‘DA-EPOCH-R’ (7-year overall survival–OS, 100%; 95%CI, 82-100), ‘HDR + LD into CODOX-M/IVAC’ (2-year OS, 84%) and ‘RD-CODOX-M/IVAC’ (4-year progression-free survival–PFS, 92%; 95%CI, 77-100); in pediatric patients, the ‘BFM-NHL-90-like’ showed promising results (3-year OS, 90%). For iBL, the ‘SC-EPOCH-RR’ demonstrated a good therapeutic profile (6-year OS, 90%; 95%CI, 60-98). The ‘Malawi 2012-2014’ (1-year OS, 73%; 95%CI, 61-85) could be the treatment choice in eBL (African countries). The main adverse events were hematological . Conclusion : The selection of chemotherapy protocols for BL should be grounded on its epidemiological variants. Further studies with higher methodological quality are needed to strength the evidence. MicroAbstract This report was the first comparing chemotherapy protocols in Burkitt lymphoma patients classified according to the World Health Organization (2008 version or later). Nine studies with a high heterogeneity regarding the composition of protocols (e.g. CODOX-M/IVAC, EPOCH, BFM, and protocols without rituximab) and outcome reporting (e.g. the overall survival for CODOX-M/IVAC varied from 72-84% [1-5 years data]) were identified.