Martine Chamuleau / Improving the lives of patients with high-grade lymphoma

There are over 50 different forms of lymphoma, a type of cancer that originates from the immune system’s network of lymph nodes, lymph vessels, and organs such as the spleen, thymus, and bone marrow. Big differences exist among the different types of lymphoma. While patients with low-grade (slow growing) lymphoma are only in need of occasional treatments and generally live for many years, patients presenting with aggressive high-grade lymphoma require immediate and intensive medical intervention to prolong life.

Burkitt Lymphoma

Originally trained in internal medicine and hematology, Professor Chamuleau has specialized in the treatment of aggressive high-grade forms of B-cell lymphoma, such as Burkitt lymphoma (BL) which is characterized by its quick growth and rapid onset of symptoms. Although BL is a rare disease, with less than 50 newly diagnosed patients in the Netherlands each year, it is relatively more common in children and young adults.

Toxic Chemotherapy

Prof. Martine Chamuleau: “Our standard treatment of patients with Burkitt lymphoma was hitting the cancer very hard using a high dosage of combined chemotherapeutic drugs, including doxorubicin, vincristine, methotrexate, cytarabine, and cyclophosphamide. Although this treatment regimen is very effective at inducing remission of the disease, it also causes a lot of damage to healthy tissues. Afterall, chemotherapy is actually just poison – it can’t discriminate cancerous cells from healthy cells.”

The long road to better treatments for BL patients

In 2014, Martine Chamuleau initiated a clinical trial to determine whether administrating a lower dosage of chemotherapy at more frequent intervals would be better for BL patients. The hypothesis was that highly toxic peak drug levels associated with severe and long-term side effects could be reduced while maintaining therapy effectiveness.

However, the rarity of the disease forced the clinical study to close earlier than planned. To cast a wider net, Prof. Chamuleau founded the world-wide Burkitt Lymphoma Network in 2022. This international collaboration involving many hospitals is essential to support the clinical studies necessary to bring about better treatments for people with BL.

Meaningful Benefits

Despite early closure of the clinical study, Prof. Chamuleau succeeded in establishing a treasure trove of treatment response data. Analysis revealed a clear trend: BL patients in the lower dosage / more frequent administration group indeed had fewer toxic effects and required less supportive care without sacrificing efficacy.

“We are still investigating how this impacts quality of life,” says Prof. Chamuleau. “But the study clearly shows that our initial rational to reduce treatment toxicity is on the right track.” At the European Hematology meeting in 2022, the study results were applauded by international clinical scientists as Martine Chamuleau concluded her main stage presentation and were published in the prestigious journal The Lancet Haematology.

Standard treatment of patients with Burkitt lymphoma involves a high dose chemotherapy with a little bit of immunotherapy. My aim is to greatly
increase the proportion of immunotherapy and reduce damaging chemotherapy for
long term benefit."

^{Martine Chamuleau, Professor of ‘Hematology, in particular high-grade B-cell lymphoma’}

‘Let rare be meaningful’

Professor Chamuleau calls for more attention to rare diseases and studies to improve the lives of those affected. “After all, everyone has a 10% chance of having one of more than 5,000 rare diseases,” she notes. But performing research on rare diseases has specific challenges. For one, patients are not readily available and often even excluded from clinical studies. In addition, from a market perspective, funding is limited as target patient’s groups are small.

In her mission to improve treatments for patients with BL, Prof. Chamuleau is focusing on implementing new and promising immunotherapies. She is collaborating closely with Amsterdam UMC’s Liquid Biopsy Center to develop new diagnostic assays relying on tumor DNA and RNA in peripheral blood of patients and also with the Imaging Center to explore innovative techniques to visualize lymphoma with new tracer molecules and the latest PET-CT scanners. “These exciting new diagnostic methods hold great potential to monitor patients’ responses to treatment in an easy, safe, quick, and very accurate way,” says Prof. Chamuleau.

In addition to being the president of the International Burkitt Lymphoma Network, she is also the chair of the national HOVON Lymphoma Working Group to find new improved and less toxic treatments through clinical studies. At Cancer Center Amsterdam, Prof. Chamuleau is a member of the Research and Valorization Boards.

“It is now a core task of universities in the Netherlands to increase our societal impact. This is particularly clear in translational and clinical cancer research for patients in need,” says Prof. Chamuleau. “We need cancer treatments that are not only lifesaving but also life-preserving. This is certainly true for rare patients with Burkitt lymphoma. That’s why I titled my talk ‘Let rare be meaningful’ – highlighting the difficulty and utter importance of finding better treatments for people with rare cancers.”

Inaugural Lecture

In her address, Martine Chamuleau will explore the insights gained from high-grade lymphoma research, the current applications of these discoveries, the potential for further advancements, and the broader societal benefits of studying such a rare disease. She will argue that these contributions extend beyond the realms of science, clinical research, and patient care to benefit society as a whole. Emphasizing the necessity of dedication, mindfulness, and a wide-ranging outlook, Prof. Chamuleau will highlight that groundbreaking discoveries often occur off the beaten path, necessitating a departure from conventional approaches.

For more information, contact Prof. Martine Chamuleau, or follow her on Twitter / X.

Publication in the Lancet Haematology

Chamuleau, Martine E.D., et al. (2023) R-CODOX-M/R-IVAC versus DA-EPOCH-R in patients with newly diagnosed Burkitt lymphoma (HOVON/SAKK): final results of a multicentre, phase 3, open-label, randomised trial. The Lancet Haematology, 10, e966 - e975. https://doi.org/10.1016/S2352-3026(23)00279-X

Funding for the described clinical study was provided by Dutch Cancer Society and the Schumacher-Kramer Foundation.

Text by Henri van de Vrugt. Photos by Marlou Pulles.

This article was created for Cancer Center Amsterdam.

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