In May 2000, I was diagnosed with Burkitt's Lymphoma, a rare and very aggressive form of B-cell non-Hodgkin's lymphoma. For adults, the prognosis for two-year event-free survival was poor. I say "was". Since the advent of the Magrath protocol--otherwise known as NCI Protocol 89-C-41 and CODOX-M & IVAC--prognosis has improved dramatically for adults. I took the Magrath protocol (May-August), all four rounds. Although my tumors melted away significantly, post-chemo tests and scans (October) were all positive. In order to enhance stem-cell collection with an eye toward what seemed then to be an inevitable autologous bone marrow transplant, and in order to kill B-lymphocytes, I took Rituxan on Halloween, my 41st birthday; Jenni Goggans brought me my favorite dinner to the hospital that night, prawns masala and saag paneer. After getting my white-blood cell count back up a bit, with GCSF, I had nine consecutive days of stem-cell collection; I barely got enough for a transplant. Instead of going ahead with the transplant, I had diagnostic abdominal surgery to check whether my post-chemo scans and tests (fromOctober), which were all positive, were false or true positives. That was December 7. Biopsies of my abdominal tumor revealed that the scans and tests were false positives. The stem cells are on ice; I hope I never have to use them, but I'm glad to have them. I am now in remission, and as of July 2006, six years out, I am feeling much better, enjoying the love of family, friends, and colleagues.
I'm not sure what this portion of my website will become, although over the past three years it has become a place that I occasionally use to keep track of the latest on Burkitt's and CODOX-M & IVAC and Rituxan. I am sure of this, however: I am immensely grateful to all those who showed their love for me and my family through their phone calls, cards, gifts, financial support, muscle in moving, babysitting, prayers, kind words, hospital visits, and sympathy. I am also immensely grateful for my oncologist at the Seattle Cancer Care Alliance, Dr. Dennis Willerford, M.D., and others who cared for me under the auspices of the UW Medical Center and the Fred Hutchinson Cancer Research Center.
What you'll find below is outlined as follows:
I. About Burkitt's Lymphoma
II. My Treatment
A. Main Treatment
B. Subsidiary Treatment
III. My Library of Journal Articles (abstracts)
A. Articles on CODOX-M
& IVAC
B. Select Articles
on Rituxan
C. Select Articles
on Burkitt's
D. Relapse
E. Other Articles
IV. Useful Websites on Burkitt's
V. Clinical Trial on Burkitt's
I. ABOUT BURKITT'S LYMPHOMA
Brief descriptionII. MY TREATMENT
A. MAIN TREATMENT: NCI PROTOCOL 89-C-4A (aliases: CODOX-M & IVAC; Magrath Regimen)
III. MY LIBRARY OF JOURNAL ARTICLES (Abstracts)Adults and children with small non-cleaved-cell lymphoma have a similar excellent outcome when treated with the same chemotherapy regimen, Journal of Clinical Oncology 1996, Vol 14, 925-934B. SUBSIDIARY TREATMENT: RITUXAN (RITUXIMAB)CODOX-M & IVAC: What it is, in brief
Cancer Care Ontario: Formulary for Magrath Protocol (November 2002)
Google search on CODOX-M (June 9, 2004, 296 hits; July 13, 2006, 685 hits)
Rituxan.com
A. ARTICLES ON CODOX-M & IVAC
IV. USEFUL WEBSITES ON BURKITT'SModified magrath regimens for adults with Burkitt and Burkitt-like lymphomas: preserved efficacy with decreased toxicity, Leuk Lymphoma 2004 Apr; 45(4): 761-7B. SELECT ARTICLES ON RITUXAN (RITUXIMAB)The Magrath regimen is effective in older adults with Burkitt's and Burkitt-like lymphomas, Proceedings of the American Society of Clinical Oncology 21 (2002), abstract 1150
An international evaluation of CODOX-M and CODOX-M alternating with IVAC in adult Burkitt's lymphoma: results of United Kingdom Lymphoma Group LY06 study, Ann Oncol 2002 Aug; 13(8): 1264-74; alternative format with graph (PDF)
CTCL: CODOX-M and CODOX-M Alternating with IVAC in Adult Burkitt’s Lymphoma: Abstract & Commentary
Rituximab (Rituxan®/MabThera®): the first decade (1993–2003), Expert Review of Anticancer Therapy 2003, 3(6): 767–779C. SELECT ARTICLES ON BURKITT'SMolecular Biology of Burkitt's Lymphoma, Journal of Clinical Oncology 2000 Nov 1; 18(21): 3707-21D. RELAPSEAdult Burkitt Leukemia and Lymphoma, Blood 15, November 2004, Vol. 104, No. 10, pp. 3009-3020
Burkitt’s Lymphoma: Clinicopathologic Features and Differential Diagnosis, The Oncologist 11 (4), April 2006: 375-383
Sunnybrook & Women's College Health Science Center: Review of BL and treatment
(Page 5, bottom, suggests stem cell transplant or hyper-CVAD)Review article: Adult Burkitt Leukemia and Lymphoma, Blood 15, November 2004, Vol. 104, No. 10, pp. 3009-3020, esp. p. 3017 (which suggests chemo again, and then stem cell transplant). Here's the passage:
For those patients with a PR or relapsed disease, the optimal salvage strategy is unknown. Combination chemotherapy with non–cross-reactive agents, including cytarabine, ifosfamide, or cisplatin, can be provided, particularly if these agents were not used front-line. However, even with non–cross-resistant chemotherapy, few to no patients with BL respond at the time of relapse. Autologous or allogeneic stem cell transplantation may represent an alternative strategy in the salvage setting; however, published series addressing high-dose therapy in BL are confounded by both selection bias and absence of detailed pathologic review. In a retrospective review from the European Group for Blood and Marrow Transplantation (EBMT), 10 adult patients with BL or BLL in first partial remission, 15 patients in second or greater remission, and 14 patients with primary refractory disease received an autologous stem transplant. Three-year OS was 37% for patients with chemosensitive relapse and 7% for patients with chemorefractory disease. In adult patients treated according to the LMB protocols, 3 patients who received an autologous transplant for refractory disease died. In this same trial, 1 of 2 patients treated with an allogeneic transplant and 1 patient treated with an autologous transplant at the time of second CR were alive 24 and 59 months following the transplant. Even less data are available regarding the efficacy of related or unrelated allogeneic transplantation in patients with BL. From 1982 to 1998, 71 patients (aged 4-48 years) with BL were reported to have received allogeneic transplant (63 matched related, 3 matched unrelated, and 4 unmatched related) at the time of either first CR or relapse. Seventy-three percent of patients had chemosensitive disease, whereas 20% were reported to have chemoresistant disease. As has been seen with autologous transplantation, disease status at transplantation (first CR and chemosensitivity) have a significant effect on OS. Interestingly, the presence of acute graft-versus-host disease had no affect on survival. In matched patients treated with an autologous transplant, the relapse rate was equivalent between the allogeneic and autologous arms and OS was superior in the autologous arm. These data call into question the existence of a graft-versus-lymphoma effect in BL. In conclusion, with few effective salvage strategies for BL and limited data regarding the role of stem cell transplantation at the time of relapse, the authors recommend that patients with BL participate in a clinical trial at the time of relapse, with consideration given to a stem cell transplantation for those patients who demonstrate chemosensitivity.Review article: Treatment Advances in Adult Burkitt Lymphoma and Leukemia, Current Opinion in Oncology 16 (5), September 2004: 429-435. Here's the abstract:RECENT FINDINGS: Current regimens have largely been derived from pediatric protocols. High complete remission rates are typically achieved, but relapse remains a problem. Recent trials have validated or built upon findings from older studies. SUMMARY: The adoption of aggressive, multiagent, short-course therapy has markedly improved outcomes, but relapse rates remain relatively high in poorer-risk cohorts. New approaches are particularly needed in older patients to improve survival rates while minimizing toxicities.
1. STEM CELL TRANSPLANTAdult Burkitt's and Burkitt-like non-Hodgkin's lymphoma--outcome for patients treated with high-dose therapy and autologous stem-cell transplantation in first remission or at relapse: results from the European Group for Blood and Marrow Transplantation, Journal of Clinical Oncology 14 (9), September 1996: 2465-2472
2. SALVAGE CHEMOTHERAPY
a. Hyper-CVADCancer Care Ontario: Formulary for Hyper-CVADb. CODOX-M & IVAC again?CNS relapse of Burkitt-like lymphoma successfully treated with initial chemotherapy-CODOX-M/IVAC. A case report
E. OTHER ARTICLESEighty-one percent event-free survival in advanced Burkitt's lymphoma/leukemia: no differences in outcome between pediatric and adult patients treated with the same intensive pediatric protocol, Ann Oncol 1997; 8 Suppl 1: 77-81Considerations for Adult Cancer Survivors, Hematology 2005 (1): 516-522
PubMed (8198 abstracts on Burkitt's on July13, 2006)V. CLINICAL TRIALS ON BURKITT'SHighWire: Library of the Sciences and Medicine (Free Abstract available on most articles; some older articles are completely free)
Articles with "Burkitt's Lymphoma" in the Title (1723 on July 13, 2006)Google Search on Burkitt's Lymphoma (24,700 entries on June 8, 2004; about 437,000 on July 13, 2006...what happened?)
All Articles about Burkitt's Lymphoma (7076 on July 13, 2006)Google search on Rituxan (2,140 results; June 2004; about 369,000 on July 13, 2006...perhaps Google has improved its search capacities)
1. ClinicalTrials.gov
Clinical Trials recruiting patients with Burkitt's Lymphoma2. NCI Cancer Research Portfolio
3. UK Medical Research Council (MRC)
LY10 trial for a less toxic version of CODOX-M & IVAC