ABCL-281: CALGB1002 Protocol in the Treatment of Adult Burkitt Lymphoma, Outcome, and Toxicity: A Single-Center Experience

Abstract

Context Burkitt lymphoma is a highly aggressive and rare non-Hodgkin lymphoma (NHL). Treatment with multidrug non-cross-resistant pediatric-inspired chemotherapy protocols usually results in high cure rates with significant toxicity. Here, we report our experience with the CALGB 1002 protocol in the treatment of adults with Burkitt lymphoma. Objective Assess the outcome of the CALGB 1002 protocol in Burkitt lymphoma and associated toxicity. Design A retrospective study with a median follow-up of 36 months. Files and medical records of adult patients diagnosed with Burkitt lymphoma and treated with CALGB 1002 protocol in King Hussein Cancer Center were reviewed from 2008 to 2017. Patients 19 patients were included, 12 (63%) were males. The median age was 33 years (range: 19–65). 11 patients (58%) had advanced-stage disease, 14 (73.6%) had extra-nodal involvement. CNS involvement was found in 2 patients (10.5%), and bone marrow involvement was found in 2 patients (10.5%). Results A total of 106 cycles were given, and the median time between cycles was 23 days (range: 19–84 days). 16 patients (84%) achieved complete response. After a median follow-up of 36 months, 3-year event-free survival and overall survival were 78.95%. 2 patients (10.5%) died because of chemotherapy-related toxicity. 2 patients (10.5%) died because of progressive disease. For toxicity: grade III–IV neutropenia and thrombocytopenia were found in 59% of chemotherapy cycles. Febrile neutropenia occurred after 52.9%, despite filgrastim and antibiotic prophylaxis. Grade III–IV mucositis complicated 48.2% of cycles. Hepatotoxicity and nephrotoxicity were reported in 47.2% and 15.1% of cycles, respectively. When stratifying patients according to the age at diagnosis ( Conclusions Although CALGB 1002 protocol can be timely administered to most adult Burkitt lymphoma patients, it is associated with significant toxicity. A risk-adapted approach and consideration of other, less toxic chemotherapeutic regimens should be considered, especially in the older age group.