Three Cases of Burkitt Lymphoma/Leukemia Treated with CODOX-M/IVAC Preceded by Prednisolone

Abstract

We present three cases of Burkitt lymphoma/leukemia that underwent treatment with prednisolone to suppress tumor growth, followed by a protocol consisting of two chemotherapy regimens : A, consisting of cyclophosphamide, doxorubicin, vinvrestine and high-dose methotrexate (CODOX-M), and B, consisting of ifosfamide, etoposide, and high-dose cytarabine (IVAC), just after definitive diagnosis. All cases, a 49-year-old male (case 1), a 70-year-old male (case 2), and a 47-year-old male (case 3), presented with severe general fatigue and fever. Laboratory examination of each patient revealed high serum lactate dehydrogenase (LDH) and serum uric acid levels, renal dysfunction, and high serum C-reactive protein. Upon admission, we started not only prophylactic therapy for tumor lysis syndrome (TLS), but also daily intravenous administration of 100mg prednisolone. The patients’ initial symptoms soon subsided, and CODOX-M/IVAC therapy was started following diagnosis as Burkitt lymphoma/leukemia. Hemodialysis therapy was required in case 1. Although all three cases achieved complete remission, cases 2 and 3 experienced recurrence in the central nervous system. It is suggested that administration of corticosteroids is useful for preventing further progression of TLS in cases of Burkitt lymphoma/leukemia presenting with high serum LDH levels.