Here’s how readers responded to a You Make the Call question about management options for a 41-year old patient with aggressive Burkitt leukemia and ALS.
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There is no evidence to support alloHCT for the treatment of newly diagnosed Burkitt lymphoma, so this patient should not undergo a transplant. I would estimate he has a 70% chance of being cured with R-CODOX-M/R-IVAC.
Marie-Christine Ngirabacu, MD
Hainaut, Belgium
ALPS is not sufficient indication for transplant. Comparing the percentage of relapses after other immunodeficiency syndromes to transplant-related mortality or chronic graft-versus-host disease after transplant, I would not proceed with alloHCT.
Michalis Michael, MD, PhD
Nicosia, Cyprus
Yes, I would recommend alloHCT with matched sibling donor for this patient, as there is high chance of relapse.
Shad Ahmed, MD
Riyadh, Saudi Arabia
I would recommend alloHCT given the patient’s underlying ALPS.
Reena Jayani, MD
Nashville, Tennessee
Yes, this patient with ALPS and Burkitt lymphoma in complete remission would benefit from alloHCT.
VA Arun, MBBS, MD
Chandigarh, India
Yes, I would recommend alloHCT for this patient.
Anastasia Skandalis, MD
Athens, Greece
In my opinion, alloHCT is indicated. Patients with Burkitt leukemia who relapse after current effective front-line therapies have a poor survival rate. Given that this patient is at high risk of relapse due to the aggressive presentation and concomitant ALPS condition, alloHCT is beneficial for consolidation. Secondly, alloHCT has shown success in patients with ALPS, especially if the disease is severe and matched donor is available.
Israr Khan, MBBS, MD
McDonough, Georgia