Dose-Dense, Short-Term CARMEN Regimen Encouraging in MYC-Translocated Lymphomas

The dose-dense, short-term CARMEN regimen resulted in a 72% five-year overall survival (OS) in patients with MYC-translocated lymphomas, according to recently published data. Encouraging survival was even seen in patients with HIV/AIDS, double-hit lymphoma, or meningeal disease.

The CARMEN regimen is a 36-day induction with weekly doses of cyclophosphamide, vincristine, rituximab, methotrexate, etoposide, and doxorubicin plus intrathecal chemotherapy, followed by high-dose cytarabine-based consolidation.

In the last decade, 68 patients with Burkitt lymphoma or high-grade B-cell lymphoma (HGBCL) were treated with this first-line regimen at five Italian centers. More than half (68%) of these patients were HIV-positive.

Patients who did not achieve complete remission after induction received BEAM-conditioned stem cell transplant after consolidation. Ninety percent of patients completed induction, and 87% completed consolidation. Seventeen of the 68 patients underwent transplant.

Six patients died of toxicity. Grade 4 hematological toxicity was common, but the researchers said it did not cause treatment discontinuation. Grade 4 non-hematological toxicity occurred in 16% of patients, and grade 4 infections occurred in 9%.

The complete remission rate was 73% for HGBCL and 78% for Burkitt lymphoma. With a median follow-up of 65 months, the five-year progression-free survival rate was 63% for HGBCL and 72% for Burkitt lymphoma. The five-year OS rates were 63% and 76%, respectively. HIV seropositivity did not have a negative effect on outcomes.

These results are similar to those reported with other intensified regimens, the researchers wrote.

“Consistency of the present results with previously reported retrospective and prospective studies lead us to consider the CARMEN treatment as a valid option for HIV-negative and HIV-positive patients with Burkitt lymphoma,” the researchers wrote. “Promising results in HGBCL and MYC translocation and double-hit lymphoma prompt us to further explore this combination in aggressive B-cell lymphomas.”

Ferreri A, Angelillo P, Erbella F, et al. Safety and efficacy of a dose-dense short-term therapy in patients with MYC translocated aggressive lymphoma. Blood Adv. 2022. doi:10.1182/bloodadvances.2022007475