Burkitt Lymphoma and Burkitt-like Lymphoma Medication

Updated: Dec 20, 2019
  • Author: Ali H Kanbar, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Medication

Medication Summary

Intensive systemic chemotherapy is the treatment of choice for this aggressive disease in all its stages. [33] Supportive medications are used to help control the adverse effects of chemotherapy, such as nausea, vomiting, tumor lysis syndrome, and infections.

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Alkylating Agents

Class Summary

Alkylating agents inhibit cell growth and proliferation.

Cyclophosphamide (Cytoxan)

Cyclophosphamide is cell cycle nonspecific and involves hepatic metabolism. This agent is chemically related to nitrogen mustards. As an alkylating agent, the mechanism of action of the active metabolites may involve cross-linking of DNA, which may interfere with growth of normal and rapidly proliferating malignant cells.

Ifosfamide (Ifex)

Ifosfamide is chemically related to nitrogen mustards and is a synthetic analogue of cyclophosphamide. This agent requires metabolic activation in the liver. The alkylated metabolites of ifosfamide have been shown to react with cellular DNA. This agent inhibits DNA and protein synthesis and, thus, cell proliferation by causing DNA cross-linking and denaturation of double helix.

Vincristine (Oncovin)

The mechanism of action of vincristine is uncertain. This agent is cell cycle specific at the M and S phases and inhibits microtubule assembly at metaphase, resulting in cell division arrest. Approximately 80% of vincristine is excreted by the liver. This agent may cause a decrease in reticuloendothelial cell function or an increase in platelet production.

Methotrexate (Folex PFS)

Methotrexate is cell cycle S-phase specific. This agent inhibits enzyme dihydrofolate reductase (DHFR), resulting in decreased conversion of folic acid to tetrahydrofolate, which is essential for DNA synthesis. Methotrexate is metabolized in the liver, and most of the drug is excreted unchanged in urine. This agent crosses the blood-brain barrier and placenta.

Cytarabine (Ara-C)

Cytarabine (Ara-C) is cell-cycle S-phase specific, blocking the progression from G1 to S phase. This agent is converted intracellularly to the active compound cytarabine-5'-triphosphate, which inhibits DNA polymerase. This inhibition, in turn, halts viral replication.

Doxorubicin (Adriamycin)

Doxorubicin is an anthracycline antibiotic that can intercalate with DNA and affects many DNA functions, including synthesis. This agent forms DNA-cleavable complexes by interacting with topoisomerase II, which is responsible for the cytocidal activity of the drug.

Doxorubicin is administered intravenously and distributes widely into body tissues, including the heart, kidneys, lungs, liver, and spleen; however, it does not cross the blood-brain barrier and is excreted primarily in bile.

Rituximab (Rituxan)

Rituximab is a genetically engineered, chimeric, murine/human monoclonal antibody directed against the CD20 antigen found on the surface of normal and malignant B lymphocytes. This antibody is an immunoglobulin (Ig) G1 kappa immunoglobulin that contains murine light- and heavy-chain variable region sequences and human constant region sequences.

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Glucocorticoids

Class Summary

The pharmacologic properties of glucocorticoid agents are therapeutically effective in various diseases, including neoplasms.

Prednisone (Sterapred)

Glucocorticoids have a lympholytic effect, although mechanism of this action is not clear.

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Urate-Oxidase Enzymes

Class Summary

Urate-oxidase enzymes can be used to treat hyperuricemia associated with malignancy.

Rasburicase (Elitek)

Rasburicase is a recombinant form (derived from Saccharomyces cervisiae-synthesized, Aspergillus flavus) of the enzyme urate oxidase, which oxidizes uric acid to allantoin. This agent is indicated for the treatment and prophylaxis of severe hyperuricemia associated with the treatment of malignancy and has an elimination half-life of 18 hours. Hyperuricemia causes a precipitant in the kidneys, which leads to acute renal failure. Unlike uric acid, allantoin is soluble and easily excreted by the kidneys.

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