Comparative efficacy and safety of obinutuzumab- versus rituximab-based immunochemotherapy in newly diagnosed burkitt lymphoma: A single-center retrospective study

Abstract Background: Burkitt lymphoma (BL) is a highly aggressive B-cell malignancy requiring intensive immunochemotherapy. While rituximab(R)combined with regimens like DA-EPOCH has improved outcomes, resistance and toxicity remain challenges. Obinutuzumab(G), a glycoengineered type II anti-CD20 monoclonal antibody, demonstrates enhanced antibody-dependent cellular cytotoxicity (ADCC) and direct cell death induction compared to rituximab in other B-cell malignancies, but its efficacy in BL is underexplored. Methods: This single-center retrospective study compared outcomes of BL patients treated with G-based intensive immunochemotherapy (from July 2022 to December 2024) versus a historical cohort treated with R-based regimens (from May 2018 to June 2022). Endpoints included complete response (CR) rate, partial response (PR) rate, progression-free survival (PFS), overall survival (OS), and treatment-related toxicity. To minimize follow-up bias, the maximum follow-up period was capped at 33 months. Results: A total of 23 BL patients were included in this retrospective cohort study. Nine received R-based immunochemotherapy (2018.05–2022.06), and 14 received G-based therapy (2022.07–2024.12). To reduce follow-up bias, the maximum follow-up duration was limited to 33 months. The 2-year OS and PFS were 38.9% and 40.0%(R-based) vs. 69.2% and 71.2%(G-based), respectively (P>0.05). A favorable trend toward improved OS and PFS was observed in the G-based group. Multivariate analysis identified older age as an independent predictor of worse OS and PFS (OS: HR=11.81, P=0.0257; PFS: HR=11.91, P=0.0224). G-based therapy was not significantly associated with long-term survival but showed a trend toward benefit (OS: HR=0.43, P=0.3214; PFS: HR=0.33, P=0.1932). Adverse event rates were comparable between groups, though non-hematologic AEs appeared more favorable in the G-based group. Conclusion: G-based immunochemotherapy demonstrated comparable short-term efficacy to R-based therapy, with a consistent trend toward improved long-term survival and a more favorable non-hematologic toxicity profile. While these findings did not reach statistical significance, they suggest a potential clinical advantage of G-based regimens in BL. Prospective studies are warranted to confirm these observations.