International Journal of Hematology

, Volume 92, Issue 5, pp 732–743 | Cite as

Modified cyclophosphamide, vincristine, doxorubicin, and methotrexate (CODOX-M)/ifosfamide, etoposide, and cytarabine (IVAC) therapy with or without rituximab in Japanese adult patients with Burkitt lymphoma (BL) and B cell lymphoma, unclassifiable, with features intermediate between diffuse large B cell lymphoma and BL

  • Dai Maruyama
  • Takashi WatanabeEmail author
  • Akiko Miyagi Maeshima
  • Junko Nomoto
  • Hirokazu Taniguchi
  • Teruhisa Azuma
  • Masakazu Mori
  • Wataru Munakata
  • Sung-Won Kim
  • Yukio Kobayashi
  • Yoshihiro Matsuno
  • Kensei Tobinai
Original Article


The feasibility and efficacy of cyclophosphamide, vincristine, doxorubicin, and methotrexate (CODOX-M)/ifosfamide, etoposide, and cytarabine (IVAC) therapy in Japanese adult patients with Burkitt lymphoma (BL) and B cell lymphoma, unclassifiable, with features intermediate between diffuse large B cell lymphoma and BL (intermediate DLBCL/BL) have never been reported. The effects of adding rituximab to CODOX-M/IVAC have not been published either. Fifteen consecutive patients with a median age of 39 years were treated with modified CODOX-M/IVAC regimen (particularly, reducing the dose of methotrexate to 3 g/m2) with or without rituximab at our institution. Although all patients developed grade 4 neutropenia and grade 3/4 thrombocytopenia/anemia, 93% had febrile neutropenia, 60% showed transaminase elevation, and 40% had mucositis/stomatitis (all grade 3), there were no treatment-related deaths. Two of nine patients treated with rituximab developed biphasic late-onset neutropenia. Thirteen patients (87%) showed complete responses. The remaining two patients had refractory disease; one had presented with peritoneal dissemination and complex chromosomal abnormalities, while the other had double IGHMYC and IGHBCL2 translocations. The estimated 5-year overall and progression-free survival were 87% each, with a median follow-up of 74 months. In conclusion, our modified CODOX-M/IVAC regimen is well tolerated and highly effective in Japanese adult patients with BL and intermediate DLBCL/BL, warranting a larger study for confirmation.


CODOX-M/IVAC Burkitt lymphoma Burkitt-like lymphoma Rituximab 



This work was supported in part by a Grant-in-Aid for Cancer Research from the Ministry of Health, Labour and Welfare of Japan (to T.W. and K.T.).

Conflict of interest

None declared.


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Copyright information

© The Japanese Society of Hematology 2010

Authors and Affiliations

  • Dai Maruyama
    • 1
  • Takashi Watanabe
    • 1
    Email author
  • Akiko Miyagi Maeshima
    • 2
  • Junko Nomoto
    • 1
  • Hirokazu Taniguchi
    • 2
  • Teruhisa Azuma
    • 1
  • Masakazu Mori
    • 1
  • Wataru Munakata
    • 1
  • Sung-Won Kim
    • 1
  • Yukio Kobayashi
    • 1
  • Yoshihiro Matsuno
    • 2
  • Kensei Tobinai
    • 1
  1. 1.Hematology DivisionNational Cancer Center HospitalTokyoJapan
  2. 2.Clinical Laboratory DivisionNational Cancer Center HospitalTokyoJapan

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