Burkitt lymphoma

Burkitt lymphoma is confirmed with a biopsy, a sample of the tumor, a swollen lymph node or sometimes bone marrow. A lab doctor (pathologist) studies the cells and their markers with flow cytometry and stains. Burkitt cells are mature B cells that usually carry CD20, and most carry CD10. More than 95% of them are dividing, measured by a stain called Ki-67. The key finding is a change that moves the MYC gene next to an antibody gene. Chromosome tests (cytogenetics) or FISH look for it.

Other tests show how far the lymphoma has spread. Blood tests check LDH, uric acid, kidney and liver function and blood salts (electrolytes). CT, PET, MRI or ultrasound scans show the tumors. A bone marrow sample and a lumbar puncture (spinal tap) check the marrow and the fluid around the brain and spinal cord.

The blood tests also watch for tumor lysis syndrome, when many cancer cells break down at once. Because Burkitt lymphoma grows so fast, this can start even before treatment begins.

Treatment uses prompt multi-drug therapy, commonly with rituximab, and treatment directed at the central nervous system. Regimens are selected according to age, fitness, disease burden and the specialist protocol.

Many patients can achieve lasting remission with initial drug treatment. High-dose treatment followed by stem cell rescue is not a routine addition for someone responding well to first-line therapy.

Relapsed or refractory Burkitt lymphoma is difficult to treat. Salvage chemotherapy, clinical trials and autologous or allogeneic transplantation may be considered for selected responders. The evidence is limited, and results from other large B-cell lymphomas cannot automatically be applied to Burkitt lymphoma.

Burkitt lymphoma grows fast, but it is often curable with intensive chemotherapy and rituximab. Children and teens do especially well. St. Jude Children's Research Hospital reports survival rates above 90% in the United States. In an international trial of children and teens with high-risk disease, adding rituximab to chemotherapy raised the share with no relapse or other event at three years from 82% to 94%.

Adults can be cured too, though real-world results are more modest than in trials. In a study of 641 adults treated at 30 U.S. cancer centers, 70% were alive after three years. Being 40 or older, poorer day-to-day fitness, an LDH more than three times normal and spread to the brain or spinal cord were linked with lower survival. People who received rituximab did better. So did people treated at academic cancer centers.

The hardest situation is Burkitt lymphoma that does not respond or comes back. For children and teens with relapsed or resistant aggressive mature B-cell lymphoma, reported survival ranges from 10% to 50%. A first remission lasting more than six months and getting back into complete remission before a transplant were linked with better results. Newer treatments, such as CAR T-cell therapy, are being studied.