Regression Of Burkitt’s Lymphoma In Association With Measles Infection

Abstract

To learn more about the natural history of low-grade non-Hodgkin’s lymphoma, the authors have studied 83 patients in whom the advanced disease was initially managed without therapy. Actuarial survival was 82% at 5 years and 73% at 10 years. The median time until therapy was required was three years. Histologic transformation to an intermediate-grade or high-grade lymphoma occurred both before and after primary therapy. The actuarial risk of transformation among the initially untreated patients was similar to that in a group of patients treated at this institution immediately after diagnosis. Neither the time to histologic transformation nor the incidence of transformation was influenced by when therapy was started. The authors considered that spontaneous regression of disease occurred if radiologic or physical examination showed evidence of regression, and the regression had to be documented on two or more occasions over more than two months. The authors defined complete regression of disease as the resolution of all clinical disease, including evidence from radiologic studies. During follow-up of the 83 initially untreated patients, spontaneous regression of disease was observed in 19 cases (23%), including 30% of patients with nodular, poorly differentiated lymphocytic lymphoma. None of the 19 patients had received treatment for their low-grade lymphoma. The median time from diagnosis to spontaneous regression was eight months. Regressions were complete in 6 patients and incomplete in the remaining 13, and were noted in patients with moderate (>3 centimeters) or minimal adenopathy. One of the complete regressions occurred after a clinical viral illness. The authors suggest several advantages in witholding treatment until there is evidence of disease progression. First, there are many unpleasant side-effects to cytotoxic therapy, including myelosuppression, which can be associated with serious, even fatal, infectious complications. Second, there have been reports among patients with the low-grade non-Hodgkin’s lymphomas of an increased incidence of acute leukemia that is related to the duration of exposure to alkylating agents. Third, spontaneous regression of disease may occur. There have been reports in the literature that indicate that 5 to 15% of patients with low-grade lymphomas have experienced spontaneous regressions. The mechanism of spontaneous regression is unknown. Disease regression after viral infection, a possible interferon effect, has been reported. The authors speculate that this mechanism may be implicated in one of their patients.