Burkitt lymphoma
Burkitt lymphoma is a type of non-Hodgkin lymphoma (NHL).
NHL is a type of blood cancer that affects white blood cells called 
. It is a cancer of the .
Burkitt lymphoma is fast growing (high grade). You have treatment soon after diagnosis. Treatment usually includes together with a called rituximab. Doctors call this chemoimmunotherapy.
This page is about Burkitt lymphoma in adults.
What is Burkitt lymphoma?
Burkitt lymphoma is a type of fast growing (high grade) NHL.
Lymphoma develops when white blood cells called lymphocytes grow out of control. They move around your body in your blood and your lymphatic system.
The lymphatic system is an important part of our immune system. It has tubes that branch through all parts of the body.
These tubes are called lymph vessels or lymphatic vessels and they carry a colourless liquid called lymph. This liquid circulates around the body tissues. It contains a high number of white blood cells (lymphocytes) which fight infection.
There are two types of lymphocytes: T lymphocytes (T cells) and B lymphocytes (B cells).
Burkitt lymphoma develops when the body makes abnormal B lymphocytes. So it is a type of B cell lymphoma. The abnormal lymphocytes build up in the lymph nodes or other body organs. They don't work properly. So they can't fight infection as normal white blood cells do.
How common is it?
Each year around 260 people are diagnosed with Burkitt lymphoma in the UK. This makes up about 2 out of 100 cases (2%) of NHL.
Burkitt lymphoma is the most common type of NHL in children in the UK. Adults can also be diagnosed, but it is more unusual.
Burkitt lymphoma is more common in males than females.
Types of Burkitt lymphoma
The are 3 main types of Burkitt lymphoma. The information in this section is mainly about sporadic and immunodeficiency-related Burkitt lymphoma.
Sporadic Burkitt lymphoma
This is the most common type of Burkitt lymphoma in the UK.
It is sometimes linked to a virus called the Epstein-Barr virus (EBV). This is the virus that causes glandular fever (mononucleosis). But it’s important to remember that EBV is very common. There are many people with EBV who never develop lymphoma.
Immunodeficiency-related Burkitt lymphoma
This type can develop in people whose immune system is not working as well as it should, because they have:
- human immunodeficiency virus (HIV)
- had an organ transplant
Endemic Burkitt lymphoma
This type of Burkitt lymphoma is most common in children in Africa. Some research suggests a link with malaria and EBV. This type is rare in the UK.
Symptoms
Symptoms of Burkitt lymphoma usually develop quickly. They can start or get worse in just a few days.
Lymphoma in the tummy (abdomen)
Sporadic Burkitt lymphoma often grows in the abdomen and bowel. You might have some of the following symptoms:
- tummy (abdominal) or back pain
- feeling or being sick
- diarrhoea
- swelling of your tummy (abdomen) as fluid collects
- bleeding
Painless swellings
You might have one or more painless swellings in the:
- neck
- armpit
- groin
These swellings are enlarged lymph nodes. They can grow very quickly.
General symptoms (B symptoms)
You might have other general symptoms such as:
- heavy sweating at night
- high temperatures that come and go with no obvious cause
- losing a lot of weight (more than one tenth of your total weight)
Doctors call this group of symptoms B symptoms. It is important to tell your doctor about any symptoms like this.
Other symptoms
General symptoms of Burkitt lymphoma can include loss of appetite and feeling very tired. Other symptoms depend on where the lymphoma grows in your body.
Burkitt lymphoma can grow in the bone marrow. Lymphoma cells can take up the space of normal blood cells. This can cause low blood cell counts. Symptoms of this includes:
- tiredness and shortness of breath
- bleeding and bruising
It might also develop in other parts of your body, such as your brain and spinal cord (central nervous system, or CNS).
See your GP if you have these symptoms.
Getting diagnosed
The main test to diagnose Burkitt lymphoma is a . A doctor removes a sample from the affected area. This often means removing part or all of a swollen lymph node. They send it to the laboratory for a specialist to look at it under a microscope. They might also take biopsies from other areas of your body.
You usually also have some blood tests.
If your doctor diagnoses Burkitt lymphoma, you usually have further tests. These might include:
- a
PET-CT scan - a
bone marrow test to check if you have lymphoma cells in your bone marrow - an
MRI scan to look at your head or spine - a
lumbar puncture to check for lymphoma cells in the fluid around your brain and spinal cord
Stages and grades
Grade
Grade describes how the cells look under a microscope. Your grade tells the doctor how quickly the lymphoma is likely to grow and spread. Doctors put NHL into 2 grades:
- low grade (slow growing)
- high grade (fast growing)
Burkitt lymphoma is fast growing and doctors call it a high grade lymphoma.
Stage
You have tests to find out the number of places in your body affected by lymphoma, and where these are. This is your stage. Doctors use your stage to plan your treatment.
Doctors use different staging systems for adults and children with Burkitt lymphoma. If your child has Burkitt lymphoma, ask your specialist to explain their stage.
There are 4 main stages of NHL (stage 1 to stage 4). Or your doctors might talk about early (limited) stage and advanced stage lymphoma.
Early stage usually means either stage 1 or stage 2 lymphoma. Advanced stage usually means either stage 3 or stage 4 lymphoma.
Low risk and high risk Burkitt lymphoma
Your doctor looks at test results to decide if you have high risk or low risk Burkitt lymphoma. Your 'risk' helps doctors to plan your treatment. They look at factors such as:
- how lymphoma affects your well being, also known as performance status
- the level of an enzyme called lactose dehydrogenase (LDH) in your blood
- whether your lymphoma is outside the lymph nodes (extranodal disease)
- the stage of your lymphoma
This helps your team to plan the best treatment for you.
Treatment for Burkitt lymphoma
The aim of treatment for Burkitt lymphoma is usually to cure it. You also have treatment to stop lymphoma spreading to other parts of the body, such as your brain and spinal cord (CNS). Talk to your doctor or specialist nurse if you want to find out more about the aim of your treatment.
Burkitt lymphoma is fast growing (high grade) so you have treatment soon after diagnosis. If there is no sign of lymphoma following treatment, this is called remission. Sometimes, lymphoma can come back (relapse). You usually have more treatment.
Treatment decisions
Your treatment depends on:
- where your lymphoma is (the stage)
- your symptoms, and how lymphoma affects your everyday life
- your general health
- levels of some chemicals in your blood (such as LDH)
- whether your lymphoma has spread to
cerebrospinal fluid
The treatment for sporadic and immunodeficiency related Burkitt lymphoma is usually the same.
The main treatments
The main treatments for Burkitt lymphoma are:
chemotherapy combined with steroids and a targeted cancer drug - doctors call this chemoimmunotherapy- chemotherapy to stop lymphoma spreading to your brain
After treatment, Burkitt lymphoma sometimes doesn't go away or comes back. Your specialist usually suggests further treatment which might include:
- chemoimmunotherapy using a different combination of drugs
- stem cell transplant
Chemotherapy and rituximab
You usually have a several chemotherapy drugs and a targeted cancer drug called rituximab (Mabthera). You might hear this combination called chemoimmunotherapy.
There are different drug combinations. Common treatments for Burkitt lymphoma include:
-
R-CODOX-M (rituximab, cyclophosphamide, vincristine, doxorubicin, and methotrexate) on its own, or together with R-IVAC (rituximab, ifosfamide, etoposide, cytarabine)
-
DA-EPOCH-R (rituximab with dose adjusted etoposide, prednisolone, vincristine, cyclophosphamide and doxorubicin)
There are other chemotherapy combinations. Your doctor might suggest a different combination, depending on your situation.
You have the chemoimmunotherapy drugs on certain days of each treatment . The length of each cycle and how many cycles you have depends on your situation.
Your treatment can be very intensive lasting several months. You might be in hospital for a lot of this time.
High risk and low risk
For high risk Burkitt lymphoma you might have R-CODOX-M and R-IVAC if you are fit enough. You usually have a cycle of R-CODOX-M followed by a cycle of R-IVAC. And then you repeat this, and have another cycle of each treatment. So you have 2 cycles of each treatment regime.
For low risk Burkitt lymphoma you might have R-CODOX-M on its own.
Or you might have DA-EPOCH-R. The number of cycles you have depends on whether you have high or low risk lymphoma. And whether you are fit enough to tolerate intensive treatment.
If you are older or less fit
You may have a less intensive treatment if you are older, or less fit and well. These might not include certain drugs or have lower doses of drugs to reduce the side effects. Or you might have fewer cycles of treatment.
You might have a treatment called R-CHOP (rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine and prednisolone).
Chemotherapy to stop spread to the brain
Some types of lymphoma (including Burkitt lymphoma) are more likely to spread to your central nervous system (CNS). The CNS is your brain and spinal cord. Your doctor might want you to have extra treatment to prevent this.
The most common treatment is injections of the chemotherapy drug methotrexate into the fluid around your spinal cord. This is called intrathecal chemotherapy. It is very similar to having a .
Or you might have a high dose of a chemotherapy drug called methotrexate. You have this into your vein (intravenously).
Chemotherapy regimes for Burkitt lymphoma usually include drugs that aim to prevent spread to the CNS. For example, CODOX-M includes methotrexate.
Treatment when lymphoma doesn't go away or comes back
Lymphoma that does not go away with treatment is called refractory lymphoma. Lymphoma that comes back after treatment is called relapsed disease.
Unfortunately it is much harder to treat Burkitt lymphoma when it relapses. There aren't very many treatment options.
You might have:
- further chemoimmunotherapy treatment
- a stem cell transplant, if treatment can bring your lymphoma under control
- radiotherapy to control symptoms
Your treatment plan will depend on what treatment you have already had, and how well you are.
Stem cell transplant
A stem cell transplant allows you to have very high doses of chemotherapy. You can have a transplant using:
- your own stem cells (autologous stem cell transplant)
- a donor’s stem cells (allogeneic stem cell transplant)
Your doctor might suggest you have an allogenic stem cell transplant if you are in after chemoimmunotherapy.
Radiotherapy
You might have radiotherapy to relieve symptoms if your lymphoma is pressing on an organ. Or if it is causing a blockage (obstruction).
Treating and preventing problems caused by lymphoma
Lymphoma and its treatment can cause problems. Supportive treatments can help to either prevent or control these problems.
Supportive treatments you might need include:
- medicines to prevent problems from the break down of lymphoma cells (tumour lysis syndrome)
- medicines to prevent infections
- injections to boost your immune system (GCSF)
Tumour lysis syndrome
When cancer drugs kill lymphoma cells, the body breaks down the dead cells. This releases chemicals into your blood. So the normal balance of chemicals circulating in your blood suddenly changes. This is called tumour lysis syndrome. It can cause serious problems with your kidneys.
You have regular blood tests to check for this if you are at risk. This is especially important at the start of treatment. It’s important to drink plenty of fluids. Your doctor might also prescribe you a tablet or drip to lower the risk of tumour lysis syndrome in the first cycle of treatment.
Follow up
You have regular follow up appointments after finishing treatment. These are appointments to check how you are. And to check if there are any signs of the lymphoma coming back. Your appointments might be every 3 months to begin with.
Your doctor will examine you and ask about any symptoms or side effects. You may have blood tests. But there are no specific blood tests that can show if the lymphoma has come back.
You can ask any questions at these appointments. Contact your health care team between appointments if you have any symptoms or concerns. You don't need to wait for a booked appointment.
Research
Researchers around the world are looking at the treatments for NHL. Your doctor might suggest you take part in a clinical trial.
Survival
The best person to talk to you about your outlook or prognosis is your doctor. Not everyone wants to know. People cope differently with their lymphoma and want different information.
Survival depends on many factors. So no one can tell you exactly how long you will live. Your doctor might be able to give you some guide, based on their knowledge and experience.
Coping with Burkitt lymphoma
Burkitt lymphoma and its treatment is likely to cause physical changes in your body. The treatment can be very intense. You will be in and out of hospital for at least a few months. These changes can be hard to cope with and can affect the way you feel about yourself.
You might also have to cope with feeling very tired and lethargic a lot of the time, especially for a while after treatment.
Ask your medical team about possible support and help.
It can help to talk to friends and family. Or join a support group to meet people in a similar situation.
Our discussion forum Cancer Chat is a place for anyone affected by cancer. You can share experiences, stories and information with other people who know what you are going through.
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