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. doi: 10.1093/annonc/mdf253.


Background: Burkitt's lymphoma (BL) is a rare and rapidly progressive form of B-cell non-Hodgkin's lymphoma. Cyclophosphamide, vincristine, doxorubicin, high-dose methotrexate (CODOX-M)/ifosfamide, etoposide and high-dose cytarabine (IVAC) is a highly effective alternating non-cross-resistant regimen developed by Magrath et al. (Magrath I., Adde M., Shad A. et al. J Clin Oncol 1996; 14: 925-934) at the US National Cancer Institute. The aim was to confirm these results in a larger, international, multi-centre study using International Prognostic Index-based criteria to assign prognostic groups, whilst slightly simplifying the protocol.

Patients and methods: A phase II study where: (i) low risk (LR) patients were treated with three cycles of modified CODOX-M; and (ii) high risk (HR) patients received treatment with four cycles of alternating modified CODOX-M and IVAC chemotherapy. Target of 60 patients, fit for protocol treatment, from 16 to 60 years of age with locally diagnosed, non-HIV-related, non-organ-transplant-related BL.

Results: Results are given for 52 of 72 registered patients whose pathological eligibility was confirmed by central pathology review: 12 LR plus 40 HR. The majority of patients (n = 41) completed protocol treatment, but toxicity was severe, especially myelosuppression and mucositis. Overall, 2-year event-free survival (EFS) was 64.6% (95% CI 50.4% to 78.9%) and 2-year overall survival (OS) was 72.8% (95% CI 59.4% to 86.3%). For LR, 2-year EFS was 83.3% and OS was 81.5%. For HR, 2-year EFS was 59.5% and OS was 69.9%.

Conclusions: This study confirms high cure rates with this CODOX-M/IVAC approach.

Publication types

  • Clinical Trial
  • Clinical Trial, Phase II
  • Multicenter Study

MeSH terms

  • Adult
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Burkitt Lymphoma / drug therapy*
  • Burkitt Lymphoma / pathology
  • Cyclophosphamide / therapeutic use*
  • Cytarabine / therapeutic use*
  • Doxorubicin / therapeutic use*
  • Drug Evaluation
  • Etoposide / therapeutic use*
  • Female
  • Humans
  • Ifosfamide / therapeutic use*
  • L-Lactate Dehydrogenase / metabolism
  • Male
  • Methotrexate / therapeutic use*
  • Middle Aged
  • Neoplasm Staging
  • Prognosis
  • Prospective Studies
  • Risk Factors
  • Survival Rate
  • Treatment Outcome
  • United Kingdom
  • Vincristine / therapeutic use*


  • Cytarabine
  • Vincristine
  • Etoposide
  • Doxorubicin
  • Cyclophosphamide
  • L-Lactate Dehydrogenase
  • Ifosfamide
  • Methotrexate

Supplementary concepts

  • ANAVACYM protocol
  • IVAC protocol