Hyper-CVAD-R May Prevent CNS Relapse in Burkitt or High-Grade B-Cell Lymphoma

Hyper-cyclophosphamide, vincristine, doxorubicin, and dexamethasone plus rituximab (hyper-CVAD-R) can prevent central nervous system (CNS) relapse in patients with Burkitt leukemia/lymphoma (BL) or high-grade B-cell lymphoma (HGBL), according to a study published in Blood Advances.

The retrospective study included 79 patients with newly diagnosed BL (n=54) or HGBL (n=25) who were treated with hyper-CVAD-R. Patients also received 16 intrathecal alternating doses of methotrexate and cytarabine as CNS prophylaxis.

At baseline, the patients’ median age was 44 years, and 65% were men. CNS disease was present in 28% of patients, bone marrow involvement was seen in 73%, and 13% were HIV-positive.

Of the 75 evaluable patients, 91% achieved a complete response. In this group, 28% of patients died, primarily due to treatment-related infections and secondary myeloid malignancies.

At 5 years, the relapse-free survival (RFS) rate was 58%, and the overall survival (OS) rate was 52%.

In a multivariate analysis, CNS involvement at baseline was an independent predictor of worse RFS and OS (P <.01 for both). Older age was also an independent predictor of worse RFS (P =.02) and OS (P <.01).

The cumulative incidence of relapse (CIR) was 21%. CIR was higher in patients with CNS involvement at baseline than in those without it — 42% and 12%, respectively (P <.01) — and in patients with bone marrow involvement at baseline than in those without it — 27% and 0%, respectively (P =.02).

“Our data support the use of hyper-CVAD-R in preventing CNS relapse, especially among high-risk patients with BM [bone marrow] or CNS involvement,” the researchers concluded.


Samra B, Khoury JD, Morita K, et al. Long-term outcome of hyper-CVAD-R for Burkitt leukemia/lymphoma and high-grade B-cell lymphoma: Focus on CNS relapse. Blood Adv. 2021;5:3913-3918. doi:10.1182/bloodadvances.2021004427