Probability of recurrence, survival rate, Burkitt's Lymphoma

Question

Dear Dr. Dezube, First of all, many thanks for your very informative answers, and what's more your genuine concern and compassion for those of us suffering this disease. I am 37, living in Germany, and was diagnosed HIV+ in March 2000 (CD4s were between 50-100, VL was 178,000). HAART started in April 2000, at which point the CD4s jumped to about 150, and have remained there ever since. VL has been undetectable since November 2000. I have never had any opportunistic infections until I was diagnosed in October 2001 with Burkitt's Lymphoma Stage IVB. I have had 4 out of 6 rounds of chemo (they seem to deviate here from the standard CHOP...my combo is: A Block: MTX, Tenopiside, Cytosine Arabinoside, Ifosfamide, Dexamethasone. B Block: MTX, Cyclophosphamide, Vincristine, Doxorubicin, Dexamethasone. Each block alternates with the other 3 times (ABABAB). Additionally some lymphoma cells were detected in my CSF, and I have had intrathecal chemo (chemotherapy into the spinal canal) once or twice weekly since mid-November (MTX, Alexan, Fortecortin). I have continued on HAART (Epivir, Ziagen, Sustiva) and my viral load is still undetected. CD4s haven't been measured since starting chemo as the doctors feel it is pointless at this stage due to the complete disruption of the immune system caused by the chemo. Until now, everything seems to be working, and I have tolerated the chemo surprisingly well. My question to you is, do you know what the likelihood is of recurrence? I've read so much about it in the internet where they arrive somehow at a median survival time of about 8 months! Of course this is most distressing, and I suppose I'm just looking for some reassurance that there ARE indeed people who do survive for long periods of time without relapse. Another question is, have you heard of this particular chemo combination? Is it to be recommended? Any insight you can give would be most appreciated! With best wishes, TD

Answer

Dear TD from Germany:

Burkitt's lymphoma is a particularly aggressive form of lymphoma. This aggressiveness actually makes the lymphoma more susceptible to chemotherapy. I have many patients with Burkitt's, including some who had it in their spinal canals, who are long term survivors. Obviously I can't give you a guarantee.

I would urge you not to believe everything you read on the internet. Most of the data on Burkitt's come from studies which were performed before the era of highly active anti-retroviral therapy (HAART). The survival rates and prognosis are much better now that HAART is available.

As for the regimen you mention-- I am not familiar with it. However, all the drugs in the regimen are very active against Burkitt's. So, not too worry. The German cancer centers have a good track record in lymphoma/leukemia management. They publish quite frequently on the subject.

Good luck! Please write back when you are completely through with your therapy. BD.