***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: A r and omized clinical trial design ed to compare the effectiveness of cytoxan ( CTX ) alone versus a combination consisting of CTX , vincristine ( Oncovin ) and methotrexate ( COM ) in the treatment of Burkitt 's lymphoma ( BL ) was carried out . Nineteen patients were selected at r and om to receive CTX alone while 21 received COM .  The two treatment regimens were equally effective in inducing remissions , and complete response rates of 83.3 % and 84.3 % were observed for CTX- and COM-treated patients , respectively . The relapse frequencies were also equal but the pattern of relapse was clearly different . Seven out of 8 ( 87.5 % ) in the CTX group relapsed with systemic and central nervous system ( CNS ) tumor , while 8 out of 10 ( 80 % ) in the COM group relapsed with CNS disease only . This difference is highly significant p = 0.008 . The remission duration s and survival to date are the same The combination of cyclophosphamide , doxorubicin , vincristine , and prednisone , given every 3 weeks ( CHOP-21 ) is st and ard chemotherapy for aggressive lymphomas . To determine whether CHOP given every 2 weeks ( CHOP-14 ) or the addition of etoposide ( CHOEP-21 , CHOEP-14 ) can improve results in patients ages 18 to 60 years with good prognosis ( normal lactic dehydrogenase [ LDH ] level ) , 710 patients were r and omized to 6 cycles of CHOP-21 , CHOP-14 , CHOEP-21 ( CHOP plus etoposide 100 mg/m2 days 1 - 3 ) , or CHOEP-14 in a 2 x 2 factorial study design . Patients in the biweekly regimens received granulocyte colony-stimulating factor ( G-CSF ) starting from day 4 . Patients received radiotherapy ( 36 Gy ) to sites of initial bulky disease and extranodal disease . CHOEP achieved better complete remission ( 87.6 % versus 79.4 % ; P = .003 ) and 5-year event-free survival rates ( 69.2 % versus 57.6 % ; P = .004 , primary end point ) than CHOP , whereas interval reduction improved overall survival ( P = .05 ; P = .044 in the multivariate analysis ) . Although the CHOEP regimens induced more myelosuppression , all regimens were well tolerated .  CHOEP should be the preferred chemotherapy regimen for young patients with good-prognosis ( normal LDH level ) aggressive lymphoma The surface Ig on each B-cell lymphoma has unique portions ( idiotypes ) , which can be recognized by the immune system . In this study , we immunized patients against the Ig expressed by their tumor and observed their clinical outcomes . After st and ard chemotherapy , 41 patients with non-Hodgkin 's B-cell lymphoma received a series of injections with a vaccine consisting of tumor Ig protein coupled to keyhole limpet hemocyanin and emulsified in an immunologic adjuvant . Subjects were observed for toxicity , immune responses , and tumor status . The median duration of follow-up of all patients is 7.3 years from diagnosis and 5.3 years from the last chemotherapy given before vaccine treatment . Twenty patients ( 49 % ) generated specific immune responses against the idiotypes of their tumor Ig . Two patients who had residual disease experienced complete tumor regression in association with the development of these immune responses . The median duration of freedom from disease progression and overall survival of all 20 patients mounting an anti-idiotype immune response are significantly prolonged compared to the patients who did not mount an immune response . Thirty-two patients were in their first remission and nine were in subsequent remissions before beginning vaccine treatments . Analysis of the 32 first remission patients also shows an improved clinical outcome for those patients who mounted a specific immune response compared to those who did not ( freedom from progression , 7.9 years v 1.3 years P = .0001 ; median survival from time of last chemotherapy not yet reached v 7 years , P = .04 ) . This study confirms an earlier report that patients with B-cell lymphoma can be induced to make a specific immune response against the Ig expressed by their own tumor . It further shows that the ability to make such an immune response is correlated with a more favorable clinical outcome . Prospect i ve controlled trials will be needed to prove a causal relationship between anti-idiotype immunity and improved clinical outcome BACKGROUND The Pediatric Oncology Group ( POG ) conducted a two-arm , r and omized study for the treatment of children and adolescents with stage III small , non-cleaved cell lymphoma ( SNCCL ) . Regimen A , based on the group 's previous best treatment for this group of patients , included cyclophosphamide ( CTX ) and high-dose methotrexate ( MTX ) , as well as vincristine ( VCR ) , prednisone ( PRED ) , and intrathecal ( IT ) chemoprophylaxis . Regimen B , based on a single institution pilot study ( Total B therapy ) , consisted of two rapidly alternating chemotherapy combinations ( CTX , VCR , doxorubicin ; MTX , and cytarabine ( Ara-C ) plus coordinated IT chemotherapy . PROCEDURE One hundred thirty-four consecutive patients were entered on this study . Seventy patients were r and omized to Regimen A , and 64 patients to Regimen B. One hundred and twenty-two patients are eligible for response . RESULTS Complete remission ( CR ) was achieved by 81 % ( 52/64 ) of patients on Regimen A , and 95 % ( 55/58 ) of patients on Regimen B ( p=0.014 one-sided ) . The two-year event-free survival ( EFS ) is 64 % ( SE=6 % ) on Regimen A , and 79 % ( SE=6 % ) on Regimen B ( p=0.027 by one-sided logrank test ) . No patient has relapsed on either regimen after a year from diagnosis , although one patient had a second malignancy at day 371 . Severe , but manageable , hematologic toxicity was seen in the majority of patients on both regimens , but was more frequent on Regimen B. CONCLUSIONS We conclude that the cure rate in stage III SNCCL is significantly improved with the use of a short , six-month chemotherapy regimen of fractionated CTX alternated with coordinated MTX and Ara-C. Results suggest that drug schedule , not simple drug selection , influences outcome Twenty-two patients with Burkitt 's lymphoma in complete remission induced by either cyclophosphamide or a combination of cyclophosphamide , oncovin and methotrexate were r and omized to receive or not to receive prophylactic cerebrospinal irradiation . Six of 11 irradiated patients  relapsed with tumour of the central nervous system as compared to 4 of 11 controls . Relapse frequency appeared to be related to stage of disease on admission . It is concluded that irradiation does not prevent relapse 39 patients with marginal zone B cell lymphoma ( MZBCL ) of the parotid gl and s ( stages I or II ) were studied . They were r and omized to be treated with either radiotherapy alone ( extended fields , 4500 cGy ) or radiotherapy ( the same schedule ) plus adjuvant chemotherapy ( cyclophosphamide , vincristine and prednisone ) . The end points were survival and time to treatment failure ( TTF ) . Patients who received radiotherapy alone had a complete remission rate of 100 % , the TTF was 90 % at 5 years and overall survival at 5 years was 90 % with no statistical difference when compared with patients who received combined therapy [ 100 , 80 and 95 % , respectively ( P = 0.5 ) ] . Although adjuvant chemotherapy was well tolerated , the use of this therapeutic approach in patients with early stage MZBCL did not offer any advantage over radiotherapy alone as the initial treatment . Until now , radiotherapy was considered the treatment of choice in this clinical setting of patients Twenty-seven children with abdominal Burkitt 's lymphoma ( stage III ) , who had achieved complete remission , were entered into a prospect i ve controlled trial of adjunct treatment with Epstein-Barr virus (EBV)-specific transfer factor ( TF ) . Two patients treated with TF and 2 controls relapsed early ( less than or equal to 12 weeks ) . Two out of 12 TF-treated patients and 5 out of 11 controls subsequently suffered relapses . Time to first late relapse was longer among TF-treated patients ( p = 0.08 ) , and no late relapse occurred while a patient was receiving TF treatment . Thus it seems that specific TF might be useful in the management of endemic Burkitt 's lymphoma and also in the treatment of other virus-associated cancers and diseases We report the up date d results of an intensive treatment protocol for children ( < 18 years ) and adults ( > or = 18 years ) with advanced B-cell lymphomas . The protocol consists of two chemotherapy regimens : A , consisting of cyclophosphamide , doxorubicin , vincristine and high-dose methotrexate ( CODOX-M ) , and B , consisting of ifosfamide , etoposide , and high-dose cytarabine ( IVAC ) . Both cycles included intrathecal chemotherapy ( cytarabine or methotrexate ) . Patients received a total of four cycles in the following sequence : A , B , A , B. Sixty-six previously untreated patients , enrolled before October 1996 , were included in the present analysis . Of these , 55 had Burkitt 's or Burkitt's-like lymphoma and 11 had diffuse large B-cell lymphoma . There were 53 males ad 13 females ; 40 were children and 26 were adults ( age range , 3 to 57 years ) . To date , 61 patients have achieved a complete response to therapy . Two patients subsequently relapsed , but one of these is a long-term survivor after further therapy and a bone marrow transplant . The event-free survival rate is 85 % at I year and beyond . The median potential follow-up period is 48 months ( range , 12 to 96 months ) for patients remaining in complete remission . Neutropenia occurred in 98 % of cycles and infection in 46 % of A cycles and 50 % of B cycles , but the duration was shortened in B cycles by the administration of granulocyte colony-stimulating factor . Positive blood cultures were observed in 21 % of A cycles and 28 % of B cycles , and there have been three toxic deaths . These results are better than those achieved with an earlier version of CODOX-M , suggesting that the addition of the IVAC regimen is responsible for the improved results . The similarity of the outcome in children and adults , however , confirms our previous observation that , at least in adults younger than 60 years with Burkitt 's or Burkitt's-like lymphomas , treatment with regimens similar to those used in children is warranted Thirty patients with human immunodeficiency virus (HIV)-associated non-Hodgkin 's lymphoma ( NHL ) receiving chemotherapy with cyclophosphamide , doxorubicin , vincristine , and prednisone ( CHOP )  were r and omized to receive either subcutaneous recombinant human granulocyte-macrophage colony-stimulating factor ( rGM-CSF ) or no additional therapy . Recombinant rGM-CSF ( at a dose of 10 - 20 micrograms/kg/d ) was given on days 1 to 10 ( early rGM-CSF ) to the first five patients , but was changed to days 4 to 13 ( delayed rGM-CSF ) of each chemotherapy cycle in subsequent patients . Compared with the control group ( N = 10 ) , the delayed rGM-CSF group ( N = 11 ) had higher mean nadirs of the absolute neutrophil count ( 0.36 v 0.89 x 10(9)/L ; P = .009 ) , shorter mean duration s of neutropenia ( 4.9 v 1.3 days ; P = .02 ) , fewer chemotherapy cycles complicated by neutropenia and fever ( 67 % v 27 % ; P = .001 ) , fewer days hospitalized for fever and neutropenia ( 4.9 v 1.8 ; P = .004 ) , fewer reductions in chemotherapy dosages , and less frequent delays in chemotherapy administration . No significant differences were observed between patients in the control group and those in the early rGM-CSF group ( N = 5 ) . Median levels of serum HIV-1 p24 antigen decreased to 18 % and 17 % of baseline values in control ( N = 4 ) and rGM-CSF groups ( N = 6 ) , respectively , 1 week following administration of the first cycle of chemotherapy . In the third week after chemotherapy , median antigen levels remained below baseline in the control group , but rose to 243 % of baseline values in the rGM-CSF group ( P = .01 ) , suggesting stimulation of HIV replication . The effect of this change in HIV activity on clinical outcome of treated patients could not be determined , and therefore the clinical significance of this finding remains unclear . Complete response rates of 67 % , 70 % , and 60 % were observed in the control , delayed rGM-CSF , and early rGM-CSF groups , respectively , with corresponding survival times of 9.0 , 11.4 , and 8.0 months The B-cell antigen CD20 is expressed on normal B cells and by nearly all B-cell lymphomas . This nonmodulating 
    Output:
    
This review does not currently provide any strong evidence on the relative effectiveness of interventions to treat Burkitt 's lymphoma .