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. 2025 Jul;25(7):e533-e540.e2.
doi: 10.1016/j.clml.2025.03.001. Epub 2025 Mar 5.

Real-World Data on Outcome of Burkitt Lymphoma and Burkitt Leukemia Treated According to the GMALL B-ALL/NHL 2002 Protocol: A Tertiary Center Experience

Ricardo Kosch  1 , Christoph Schaefers  2 , Christian Frenzel  2 , Walter Fiedler  2 , Katja Weisel  2 , Carsten Bokemeyer  2 , Christoph Seidel  2 , Finn-Ole Paulsen  2
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Free article

Real-World Data on Outcome of Burkitt Lymphoma and Burkitt Leukemia Treated According to the GMALL B-ALL/NHL 2002 Protocol: A Tertiary Center Experience

Ricardo Kosch et al. Clin Lymphoma Myeloma Leuk. 2025 Jul.
Free article

Abstract

Introduction: Burkitt lymphoma (BL) or leukemia represents a highly aggressive B-cell malignancy requiring intense therapy. Although various different protocols have emerged, few real-world data exist for the GMALL B-ALL/NHL 2002 regimen. Comparative analyses remain challenging because of the disease's rarity.

Methods: This retrospective study examined the overall response rate (ORR), progression-free survival (PFS), overall survival (OS), and toxicity in adult patients (pts) with histologically confirmed BL who received the GMALL protocol at the University Medical Center Hamburg-Eppendorf (2012-2022). Statistical analysis identified prognostic factors affecting outcomes.

Results: A total of 48 pts (median age 51.5 years, range 22-78) were included. Most presented with Ann Arbor stage IV (68.7%) and high-risk disease by the BL-IPI (54.1%). Burkitt leukemia was present in 27.1%, HIV positivity in 27%, and CNS involvement in 18%. The ORR was 81.6% (73.5% complete response, 8.1% partial response). After a median follow-up of 38 months (range 0-103), the median PFS and OS were not reached; 3-year rates for both PFS and OS were 73%. While not confirmed in multivariate analysis, Burkitt leukemia (HR 3.86, P = .021) and any bone marrow involvement (HR 3.80, P = .049) emerged as adverse prognostic indicators. Severe mucositis (grade ≥ 3) was common (91.7%), and 87.5% experienced at least one febrile neutropenia episode. No grade 5 treatment-related toxicity was observed.

Conclusion: 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.

Keywords: Central nervous system; Febrile neutropenia; Infiltration mucositis; Intensive chemotherapy; Non-Hodgkin lymphoma.

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Conflict of interest statement

Disclosure R.K. reports travel expanses from Amgen and Sanofi. C. Schaefers reports consultancy for Acus Health, Astra Zeneca, Janssen-Cilag, Menarini Stemline, Pfizer; honoraria from Abbvie, Astra Zeneca, Janssen-Cilag; other (travel expanses/congress support): Acus Health, Astra Zeneca, Bristol Myers Squibb, Menarini Stemline, oncopeptides, Sanofi. W.F. reports grants, personal fees and nonfinancial support from Amgen, Apis and Pfizer; personal fees from Abbvie, Jazz Pharmaceuticals, Celgene, Morphosys, Incyte, Stemline Therapeutics, Daiichi Sankyo, and Servier outside the submitted work; and support for medical writing: Amgen, Pfizer, and AbbVie. K.W. reports research grants from Abbvie, Amgen, BMS/Celgene, GSK, Janssen, Sanofi (to the Institution); honoraria from Abbvie, Amgen, Adaptive Biotech, Astra Zeneca, Beigene, BMS, Celgene, Janssen, GSK, Karyopharm, Menarini, Novartis, Oncopeptides, Pfizer, Roche, Sanofi, Stemline, Takeda; advisory roles for Abbvie, Amgen, Adaptive Biotech, Beigene, BMS, Celgene, Janssen, GSK, Karyopharm, Menarini, Novartis, Oncopeptides, Pfizer, Regeneron, Roche, Sanofi, Takeda. C.B. reports honoraria from AOK Germany, AstraZeneca, Roche, med update; advisory role for BMS, Janssen, Merck, Oncology Drug Consults CRO, Sanofi. C.F., C. Seidel and F.-O.P. have nothing to declare.

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