TOPLINE:
The German Multicenter Study Group for Adult Acute Lymphoblastic Leukemia (GMALL) B-ALL/NHL 2002 protocol achieved a 3-year overall survival and progression-free survival of 73% in adult patients with Burkitt lymphoma/leukemia (BL). While demonstrating efficacy comparable with international standards, the protocol was associated with significant toxicity, including high rates of severe mucositis and febrile neutropenia.
METHODOLOGY:
- Researchers conducted a retrospective analysis at the University Medical Center Hamburg-Eppendorf (2012-2022) in Hamburg, Germany, examining overall response rate, progression-free survival, overall survival, and toxicity in adult patients with histologically confirmed BL.
- A total of 48 patients (median age, 51.5 years; range, 22-78 years) were included, with most presenting with Ann Arbor stage IV (68.7%) and high-risk disease, as stratified by the BL International Prognostic Index (54.1%).
- Patient characteristics included BL in 27.1%, HIV positivity in 27%, and central nervous system involvement in 18%.
- Treatment consisted of four to six cycles of dose-dense intensive chemotherapy incorporating hyperfractionated cyclophosphamide/ifosfamide, high-dose cytarabine and methotrexate, doxorubicin, etoposide, vincristine, dexamethasone, rituximab, and intrathecal chemotherapy.
TAKEAWAY:
- The overall response rate was 81.6%, with 73.5% achieving complete response and 8.1% achieving partial response.
- At a median follow-up of 38 months (range, 0-103), the 3-year rates for both progression-free survival and overall survival were 73%.
- Univariate analysis identified BL (hazard ratio [HR], 3.86; P = .021) and bone marrow involvement (HR, 3.80; P = .049) as adverse prognostic indicators.
- Severe mucositis (grade > 3) occurred in 91.7% of patients, and 87.5% experienced at least one febrile neutropenia episode.
IN PRACTICE:
“These real-world findings underscore the efficacy of the GMALL protocol in BL management, with outcomes comparable to established regimens but coupled with high toxicity rates. Further comparative trials are essential to define the optimal therapeutic strategy,” wrote the authors of the study.
SOURCE:
The study was led by Ricardo Kosch, MD, University Medical Center Hamburg-Eppendorf. It was published in March in Clinical Lymphoma, Myeloma and Leukemia.
LIMITATIONS:
Due to BL being a rare neoplasm affecting a heterogeneous group of patients, limited real-world efficacy and toxicity data exist on the GMALL protocol. The protocol is accompanied by significant dose-limiting toxicity requiring intense supportive care measures and prolonged hospital stays. The researchers noted higher mortality among older patients in the original cohort, primarily due to infectious complications in 90% of cases, which may have contributed to reduced overall survival in this age group.
DISCLOSURES:
Kosch disclosed ties with Amgen and Sanofi. Christoph Schaefers reported relationships with Abbvie, Acus Health, AstraZeneca, Janssen-Cilag, Menarini Stemline, and Pfizer. Walter Fiedler disclosed ties with Amgen, Apis, and Pfizer. Katja Weisel and Carsten Bokemeyer reported relationships with various pharmaceutical companies. Additional disclosures are noted in the original article.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
