Outcome of Adult Lymphoblastic Lymphoma Patients Treated in the Real Life According to the Gimema LAL1913 Protocol: A Campus ALL Multicenter Study

The introduction of pediatric-inspired chemotherapy protocols for acute lymphoblastic leukemia (ALL) in the setting of adult patients affected by lymphoblastic lymphoma (LL) has improved the results in terms of outcomes. Within the Campus ALL network, we retrospectively collected data on 50 LL-patients from 23 hematology centers in Italy treated according to the GIMEMA LAL1913 protocol, with the aim of confirming the ALL results and of testing the effectiveness of an approach based on higher cumulative doses of the non-myelosuppressive components such as steroids and pegylated asparaginase, in addition to earlier and more intensive central nervous system prophylaxis. After cycle 3 (high dose methotrexate and cytarabine, C3), the cumulative incidence (CI) of PET-based complete response (CR) was of 83% (median time to response from protocol start: 3.7 months; CI95%: 3.1-4.2). With a median follow-up of 27.5 months, the 2-year overall survival (OS), disease free survival (DFS) ed event free survival rates were of 77%, 76% and 69%, respectively. The 2-year CI of relapse was of 26%. Multivariable analysis identified ECOG ≥ 2 as an independent prognostic factor for OS (HR = 3.279; CI95% 1.035-10.389, p = 0.044) and DFS (HR = 13.00, ICI95%: 3.383-57.909, p < 0.001), respectively. No significant impact was observed for pegylated asparaginase dose (reduced and/or omitted versus (vs.) full doses), age (≥ 55 vs. < 55), stage (0-I vs. II-IV), CD1a (negativity vs. other than CD1a negativity), bone marrow involvement (absent vs. ≤ 20%), or allotransplantation. The results of this study show the appropriateness of the LAL1913 protocol for the management of LL patients. Survival outcomes reflect those expected, although this drug combination was never tested before in a real-life setting. Taken together, these results suggest that LAL1913 might be considered as a reference protocol for the frontline treatment of adult LL patients.

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Journal
Hematological Oncology
Published
2025-11-01
DOI
https://doi.org/10.1002/hon.70153
Primary Topic
Acute Lymphoblastic Leukemia research
Type
article
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article

Outcome of Adult Lymphoblastic Lymphoma Patients Treated in the Real Life According to the Gimema LAL1913 Protocol: A Campus ALL Multicenter Study

Antonino Mulè, Anna Candoni, Fabio Guolo, Michelina Dargenio et al.
Hematological Oncology
Acute Lymphoblastic Leukemia research
article

Outcome of Adult Lymphoblastic Lymphoma Patients Treated in the Real Life According to the Gimema LAL1913 Protocol: A Campus ALL Multicenter Study

Antonino Mulè, Anna Candoni, Fabio Guolo, Michelina Dargenio, Nicola Fracchiolla, Silvia Imbergamo, Federico Mosna, L. Santoro, Matteo Leoncin, Marco De Gobbi, Sabina Chiaretti, Cristina Papayannidis, A. Curti, Pellegrino Musto, Maria Ilaria Del Principe, Matteo Olivi, Federico Lussana, Monia Lunghi, Davide Lazzarotto, Lara Aprile, Patrizia Zappasodi, Massimiliano Bonifacio, Fabio Giglio, Crescenza Pasciolla, Maria Ciccone, Vincenzo Gagliardi, Mario Delia, Monica Fumagalli, Roberto Foà
article en

Abstract

The introduction of pediatric-inspired chemotherapy protocols for acute lymphoblastic leukemia (ALL) in the setting of adult patients affected by lymphoblastic lymphoma (LL) has improved the results in terms of outcomes. Within the Campus ALL network, we retrospectively collected data on 50 LL-patients from 23 hematology centers in Italy treated according to the GIMEMA LAL1913 protocol, with the aim of confirming the ALL results and of testing the effectiveness of an approach based on higher cumulative doses of the non-myelosuppressive components such as steroids and pegylated asparaginase, in addition to earlier and more intensive central nervous system prophylaxis. After cycle 3 (high dose methotrexate and cytarabine, C3), the cumulative incidence (CI) of PET-based complete response (CR) was of 83% (median time to response from protocol start: 3.7 months; CI95%: 3.1-4.2). With a median follow-up of 27.5 months, the 2-year overall survival (OS), disease free survival (DFS) ed event free survival rates were of 77%, 76% and 69%, respectively. The 2-year CI of relapse was of 26%. Multivariable analysis identified ECOG ≥ 2 as an independent prognostic factor for OS (HR = 3.279; CI95% 1.035-10.389, p = 0.044) and DFS (HR = 13.00, ICI95%: 3.383-57.909, p < 0.001), respectively. No significant impact was observed for pegylated asparaginase dose (reduced and/or omitted versus (vs.) full doses), age (≥ 55 vs. < 55), stage (0-I vs. II-IV), CD1a (negativity vs. other than CD1a negativity), bone marrow involvement (absent vs. ≤ 20%), or allotransplantation. The results of this study show the appropriateness of the LAL1913 protocol for the management of LL patients. Survival outcomes reflect those expected, although this drug combination was never tested before in a real-life setting. Taken together, these results suggest that LAL1913 might be considered as a reference protocol for the frontline treatment of adult LL patients.

Hematological OncologyVol. 43(6)
University of Rome Tor Vergata (IT), Università degli Studi del Piemonte Orientale “Amedeo Avogadro” (IT), University of Padua (IT), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (IT), Azienda Ospedaliera Citta' della Salute e della Scienza di Torino (IT), Ospedale Maggiore (IT), Ospedale di Bolzano (IT), Azienda Ospedaliera Universitaria Integrata Verona (IT), Azienda Universitaria Ospedaliera Consorziale - Policlinico Bari (IT), Ospedale Vincenzo Cervello (IT), Ospedale Papa Giovanni XXIII (IT), Azienda Ospedaliero-Universitaria di Modena (IT), Azienda Ospedaliera San Gerardo (IT), Azienda Ospedaliera S.Giuseppe Moscati (IT), Istituto di Ematologia di Bologna (IT), Azienda Ospedaliero Universitaria Maggiore della Carita (IT), Azienda Ospedaliera S.Maria (IT), Ospedale Santa Maria della Misericordia di Udine (IT), Arcispedale Sant'Anna (IT), Istituto Tumori Bari (IT), IRCCS Ospedale San Raffaele (IT), Ospedale dell' Angelo (IT), Azienda Ospedaliera Ospedale Maggiore (IT), Ospedale Policlinico San Martino (IT), Azienda Ospedale - Università Padova (IT), Ospedale San Giuseppe (IT), Policlinico San Matteo Fondazione (IT), Ospedale Vito Fazzi (IT), Istituti di Ricovero e Cura a Carattere Scientifico (IT), Ospedale San Luigi Gonzaga (IT), Istituto Nazionale di Fisica Nucleare, Sezione di Roma I (IT), Gruppo Italiano per il Trapianto di Midollo Osseo (IT), University of Bari Aldo Moro (IT), Sapienza University of Rome (IT)
Openalex Percentile: Top 56%
Acute Lymphoblastic Leukemia research
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