Burkitt’s lymphoma



OVERVIEW

Definition

Burkitt’s lymphoma is a type of non-Hodgkin’s lymphoma consisting of medium-sized neoplastic B cells, often with “starbursts,” which may originate from mature B cells in follicular growth centers.

Burkitt’s lymphoma is rapid in onset and progression, highly malignant and aggressive.

Lymphocytes are a central component of the immune system, connecting lymphoid organs to lymphoid tissue in other organs as a functional whole.

Lymphocytes include thymus-dependent lymphocytes (T-cells), bone marrow-dependent lymphocytes (B-cells), and large granular lymphocytes (mostly NK cells).

B cells are antibody-producing lymphocytes in the body, and follicular growth centers, also known as secondary lymphoid follicles, are important sites for B cell responses to specific antigens.

Classification

Classification is based on clinical manifestations, morphology and biological features.

Endemic Burkitt’s lymphoma

Also known as endemic Burkitt’s lymphoma.

Occurring primarily in the African region located near the equator, the vast majority of Burkitt’s lymphomas in this region are associated with EBV infection.

It usually affects the maxillofacial and pharyngeal areas, but can also affect the jejunum, ileum, omentum, ovaries, kidneys, mammary glands, and other organs.

Sporadic Burkitt’s lymphoma

Burkitt’s lymphoma that occurs outside of endemic areas may or may not be associated with EBV infection.

The lesions occur mainly in the terminal ileum, abdominal organs, etc. Abdominal swelling is a common symptom.

Immunodeficiency-related Burkitt’s lymphoma

Associated with immunodeficiency and most often affects the lymph nodes.

Pathogenesis

Burkitt’s lymphoma is the most common type of non-Hodgkin’s lymphoma in children.

The pathologic classification of non-Hodgkin’s lymphomas is lymphoblastoid lymphoma, mature B-cell lymphoma, and mature T-cell and NK-cell lymphomas. Burkitt’s lymphoma is a mature B-cell lymphoma, which accounts for 1% to 2% of all non-Hodgkin’s lymphomas.

Burkitt’s lymphoma occurs well in young people. The African region near the equator is the endemic area of EBV, which is also the high incidence area of Burkitt’s lymphoma, and the incidence of the disease is mainly in children, and there are more males than females.

The incidence of Burkitt’s lymphoma in China is relatively low, and it occurs mostly in children and young people.

Causes

Pathogenic factors

Gene mutation

More than 90% of Burkitt’s lymphomas have a C-MYC gene translocation, i.e., a translocation with t(8;14)(q24;q32).

There is a variant of Burkitt’s lymphoma called “Burkitt-like lymphoma with chromosome 11q abnormality”, which does not have C-MYC gene expression, but has chromosome 11q abnormality and overexpression of PAFAH1 B2.

EBV infection

The vast majority of endemic Burkitt lymphomas and some sporadic Burkitt lymphomas are associated with EBV infection.

Immunodeficiency

Immunodeficiencies include both congenital and acquired.

Congenital immunodeficiencies include severe combined immunodeficiency and X-linked lymphoproliferative disorders.

Acquired immunodeficiency diseases include acquired immunodeficiency syndrome, lymphoproliferative disorders occurring in organ transplantation, etc.

People with human immunodeficiency virus (HIV) infection have a more than 100-fold increased risk of developing non-Hodgkin’s lymphoma.

Others

Hair dyes, insecticides, organic solvents, ultraviolet light, smoking, and high-fat diets are also associated with the development of non-Hodgkin’s lymphoma.

Pathogenesis

The pathogenesis of Burkitt’s lymphoma is not fully understood and may involve the following processes.

The C-MYC gene can regulate cell proliferation, and after the occurrence of translocation, the cells are in a proliferative state, so the alteration of the C-MYC gene is an important step in the development of lymphoma.

Persistent EBV infection can impair immune function and activate oncogenes, leading to malignant proliferation of B lymphocytes.

Symptoms

Main Symptoms

Swelling

Endemic Burkitt’s lymphoma tends to invade the maxillofacial and pharyngeal areas first, which may be manifested as jawbone swelling, huge mass in the neck, which may be accompanied by loose or premature eruption of teeth, and affected orbits.

The most common symptoms of sporadic Burkitt’s lymphoma are abdominal mass and so on.

The mass may grow rapidly and increase in size.

Symptoms of compression and infiltration

Enlarged lymph nodes compressing the surrounding structures, or tumor infiltrating the related organs, etc. can cause corresponding symptoms, which vary due to the wide distribution of the lymphatic system.

Abdominal symptoms may include abdominal pain, nausea, vomiting, change of bowel habit (diarrhea or constipation), increase of abdominal circumference, and abdominal distension.

Nasopharyngeal symptoms may include nasal congestion, snoring, bloody discharge, and difficulty in inhaling.

Neurologic symptoms may include headache, vomiting, facial paralysis, sensory loss of varying degrees, and abnormal eye movement.

Bone marrow involvement may be manifested by susceptibility to infection, bleeding (nosebleeds, bleeding spots under the skin, etc.), fatigue, and pallor.

Chest symptoms may include chest pain, irritating cough, shortness of breath, difficulty in lying down, dyspnea, and cyanosis (bruising of lips and fingertips).

When it affects the testicles, it may be characterized by enlargement of one or both testicles and lack of elasticity to the touch.

Other symptoms

Non-specific symptoms such as fever, night sweats (sweating during sleep), weight loss, and itchy skin may occur.

Consultation

Department of Medicine

Department of Hematology

Prompt medical attention is needed in the event of jaw enlargement, a large neck mass, or an abdominal mass.

Lymphoma Treatment Center

If you are diagnosed with Burkitt’s lymphoma, you can also visit the Lymphoma Center at the Oncology Hospital.

Preparation

How to get to the clinic: registering, preparing documents, and frequently asked questions.

Tips for Medical Treatment

Burkitt’s lymphoma has no specific symptoms in the early stage and is easy to be overlooked. Therefore, people with a family history of lymphoma should undergo regular medical checkups for cancer prevention.

The lesions of Burkitt’s lymphoma can involve all organs and tissues of the body, especially the head and neck, abdomen, bone marrow, etc. are the places worth focusing on.

Preparation Checklist for Medical Consultation

Symptom checklist

Particular attention needs to be paid to the time of onset of symptoms, special manifestations, etc.

Is there any jaw mass, neck mass?

Is there any abdominal pain, nausea, vomiting, change in bowel habits?

Any unexplained persistent fever?

Any recent localized and generalized skin itching?

Medical History Checklist

Is there any family history of lymphoma or other malignant tumor?

Any history of radiation therapy?

Are there any infections such as EBV, Human Immunodeficiency Virus (HIV), etc.?

Are there any immune system disorders such as rheumatoid arthritis, dry syndrome, etc.?

Any history of organ transplantation?

Any drug or food allergies?

Checklist

Test results of the last 6 months, which can be brought to the doctor’s office

Specialized tests: blood smear, bone marrow imaging, lymph node biopsy

Laboratory tests: blood test, urine test, stool test, biochemical test

Imaging tests: ultrasound, CT, MRI, PET-CT.

Diagnosis

Diagnostic basis

Histopathology and molecular biology tests can definitively diagnose Burkitt’s lymphoma, and imaging and other laboratory tests can help stage the disease, define treatment options, monitor treatment effects, and evaluate disease outcomes.

Medical History

EBV infection, HIV infection, etc. may be present.

Clinical manifestations

Symptoms

There may be a mass in the jaw, neck, or abdomen, which may be accompanied by loose teeth and abdominal pain.

Physical signs

Swellings in different parts of the body can be detected by visual inspection and palpation, such as enlarged jawbone and abdominal swelling.

Lymph nodes in superficial locations can be touched to understand the texture, size, relationship with surrounding structures, and the presence of pain on touch or pressure, etc. Generally, the texture is tougher and there is no pain on touch.

Enlarged lymph nodes can be moved, or they can adhere to each other and fuse into a mass.

Laboratory Tests

Routine blood tests

Red blood cell count, platelet count and other indicators can understand whether there is a decrease in blood cells, etc. If there is a decrease, it indicates that there may be bone marrow infiltration.

Blood biochemistry tests

Blood biochemistry tests include creatinine, aspartate aminotransferase, alanine aminotransferase, etc., which can help to understand the function of kidneys and liver.

Abnormal liver function and kidney function suggests that there may be tumor infiltration.

Serum lactate dehydrogenase measurement

Serum lactate dehydrogenase level is positively correlated with the level of tumor load (which can be simply interpreted as the amount of cells or extensiveness of the tumor in the body), i.e., a high serum lactate dehydrogenase level indicates a high tumor load and vice versa.

Tumor load can be determined based on serum lactate dehydrogenase levels and can influence the final treatment plan.

Serum lactate dehydrogenase level is also associated with prognosis, and those with high serum lactate dehydrogenase levels have a relatively poor prognosis.

Blood cytology, bone marrow cytology

Bone marrow cytology is mainly performed by obtaining a sample through bone marrow aspiration.

Tumor cells can be found in bone marrow smears in some patients.

In the early stages of a tumor, it can help identify diseases such as leukemia.

If there is concurrent lymphoma leukemia, a leukemia-like bone marrow picture may be found.

Pathogen Detection

Burkitt’s lymphoma is closely related to EBV infection, and can detect the presence or absence of EBV genes in tumor cells, etc., to help identify the cause of the disease and clarify the diagnosis.

HIV antibody test can help to detect the cause of the disease.

Imaging examination

CT examination

CT is the most commonly used imaging method. Generally, all patients with non-Hodgkin’s lymphoma need to have CT of the neck, chest, abdomen, pelvis and other related areas before, during and after treatment.

CT and enhanced CT can clearly show the size and density of lymph nodes, their relationship with surrounding blood vessels and organs, as well as extra-nodal lesions, so it is very important for the staging, efficacy evaluation and follow-up of Burkitt’s lymphoma.

Magnetic Resonance Imaging (MRI)

Magnetic resonance imaging shows soft tissue more clearly and is the test of choice for evaluating lesions in the central nervous system, bone marrow, and muscular areas.

MRI is also required if enhanced CT is not acceptable or for further examination of parenchymal organ lesions such as the liver, spleen, kidneys, or uterus.

PET-CT

PET-CT is the best test for staging, efficacy evaluation and prognosis prediction.

It can show the metastasis of the tumor and evaluate the tumor load.

PET-CT after treatment can help determine the efficacy.

It can detect hidden bone marrow and neurological invasion, and can help to accurately stage the tumor before treatment and with or without recurrence after treatment.

Ultrasound

It can be used for diagnosis and review of superficial lymph nodes and superficial organ (e.g., testes, thyroid, breast, etc.) lesions, but is generally not used for staging diagnosis of lymphoma.

It can be used selectively for abdominal and pelvic lymph node examination.

For the evaluation of abdominal and pelvic substantial organs such as liver, spleen, kidney, uterus, etc., it can be used as a supplement to CT and MRI, especially if the patient is unable to undergo enhanced CT scanning.

In superficial lymph node dissection biopsy, selecting ultrasound to detect sonographically abnormal lymph nodes can help improve the accuracy of the biopsy.

Ultrasound-guided puncture biopsy is also used in the diagnosis of lesions in the deep lymph nodes, liver, and mediastinum.

Isotope bone scan

It is of greater significance than CT for follow-up observation and prognosis assessment after treatment of primary bone lymphoma.

Gastrointestinal barium angiography

Gastrointestinal barium contrast is a commonly used method to diagnose gastrointestinal non-Hodgkin’s lymphoma.

Gastric non-Hodgkin’s lymphoma: the gastric mucosa shows “cobblestone-like” changes, the lesions are mainly located in the submucosa, and gastric peristalsis still exists when the lesions are extensive, which is the main basis for differentiating from gastric cancer.

Non-Hodgkin’s lymphoma of the small intestine: there are many scattered and well-margined filling defects in the small intestine, or coexistence of intestinal stenosis and dilatation.

Colorectal non-Hodgkin’s lymphoma: it is common in the rectum and cecum, presenting as nodular or mass filling defects with narrowing and thickening of the intestinal wall.

Pathologic examination

Pathologic examination is the main means of diagnosing lymphoma.

Principles of examination

Lymph node lesions: the doctor will remove as many intact lymph nodes as possible. If the lymph node lesions are located superficially, mostly cervical, supraclavicular and axillary lymph nodes will be selected.

Hollow-core needle aspiration: This may be used in patients who are unable to effectively and safely obtain resection or excise diseased tissue.

Initial diagnosis and recurrence: For initial diagnosis, resection or excision of the lesion tissue is mostly preferred; for recurrence, if a specimen of resected or excised lesion tissue is unavailable, pathological diagnosis may be made from the lesion tissue obtained by hollow-core needle aspiration.

Diagnostic methods

Morphology: very important in the pathological diagnosis of lymphoma, different types of lymphoma have characteristic and diagnostic morphological features.

Immunohistochemistry (IHC): can be used to identify the immunophenotype of lymphoma cells, such as B or T/NK cells, differentiation and maturity of tumor cells. Differential diagnosis of different pathologic subtypes is performed by combining relevant IHC markers.

Fluorescence in situ hybridization (FISH) detection technology: It can detect specific chromosomal breaks, translocations or amplifications, etc., which is instructive for the adjunctive diagnosis of specific chromosomal abnormality-associated lymphomas.

The discovery of Burkitt’s lymphoma-associated gene alterations such as t(8;14), 11q amplification, etc. is of diagnostic significance.

Lymphocyte antigen receptor gene rearrangement detection technology: monoclonal rearrangement of lymphocyte receptor genes is a major feature of lymphoma cells. It can be used to assist in identifying the monoclonal versus polyclonal nature of lymphocyte proliferation, as well as lymphomas that cannot be diagnosed by IHC, and is an important complement to morphology and IHC tests.

Others: Including in situ hybridization, second-generation sequencing (NGS), flow cytometry, etc., which are useful complements to conventional pathologic diagnostic methods.

Examination results

In typical Burkitt’s lymphoma, histopathological light microscopy reveals a diffuse infiltrate with a high proliferation rate, as well as a high apoptosis rate of single, medium-sized neoplastic B-cells, often with “starbursts”, which are caused by phagocytosis of apoptotic tumor cells by macrophages.

Tumor cells may be arranged in a paving-stone or mosaic pattern, with rounded nuclei, coarse chromatin, relatively clear parachromatin, multiple (usually 2-5) basophilic nucleoli, medium size, and centrally located nuclei. The cytoplasm is deeply basophilic, often with lipid vacuoles, and nuclear schizophrenia is common.

Burkitt’s lymphoma cells express membrane IgM, a single light chain, B-cell-associated antigens (e.g., CD19, CD20, CD22), CD10, and Bcl-6, and do not express Bcl-2, CD5, CD23, or TdT.

The nuclear proliferation index was very high, presenting >95% Ki-67 positive cells.

Presence of immunoglobulin heavy chain and light chain rearrangements, with autosomal mutations in immunoglobulin genes (consistent with genotypes in the differentiation stage of the germinal center).

MYC translocations are present in almost all cases, with t(8;14)(q24;q32) accounting for approximately 80% of cases, and t(2;8)(p12;q24) and t(8;22)(q24;q11) accounting for 15%; other genetic alterations include p53 deletions and mutations.

Other

Gastroscopy and enteroscopy: patients with suspected gastrointestinal tract invasion require gastroscopy and enteroscopy.

Cardiac examination: electrocardiography is routinely performed; echocardiography is selectively performed in patients with underlying cardiovascular disease, advanced age, or proposed anthracycline application.

Pulmonary function tests: those who are proposed to use bleomycin and have underlying lung disease need to perform pulmonary function tests.

Staging

Ann-Arbor staging

Ann-Arbor staging is the current universal staging system for describing Hodgkin’s lymphoma and non-Hodgkin’s lymphoma.

Stages

Stage I: invasion of a single lymph node area (I), or invasion of a single extra-lymph node organ or site (IE).

Stage II: invasion of two or more lymph node areas on one side of the diaphragm (II) or plus limited invasion of a single extra-nodal organ or site (IIE).

Stage III: invaded lymph node areas on both sides of the diaphragm (III) or plus limited invasion of one extranodal organ or site (IIIE) or the spleen (IIIS) or both (IIIES).

Stage IV: diffuse or disseminated invasion of one or more extranodal organs with or without lymph node invasion.

Recording symbols

The following recording symbols may be used for the site of involvement:

E: Extranodal, lymphoma involving organs outside the lymph nodes.

When a single extranodal site is invaded and the lesion invades an organ/tissue that is directly connected to a lymph node/lymphoid tissue, it is not recorded as stage IV.

The letter “E” should be entered after each stage (e.g., if the lesion infiltrates into the skin connected to the left cervical lymph node, it is recorded as “IE”).

X: large mass, tumor diameter > 1/3 of chest width or fusion mass > 7.5 cm in diameter.

Others: M (bone marrow), S (spleen), H (liver), O (bone), D (skin), P (pleura), L (lung).

Grouping

Each stage can be subdivided into Group A and Group B according to the presence or absence of systemic symptoms.

Group A: no systemic symptoms.

Group B: Systemic symptoms, including unexplained fever (>38°C for 3 or more consecutive days), night sweats (e.g., profuse sweating during sleep requiring change of bed sheets or covers for 7 or more consecutive days), or weight loss (more than a 10% decrease in body weight over a period of 6 months with no other explainable cause).

St. Jude staging

Children’s non-Hodgkin’s lymphoma mostly affects extra-lymph node tissues and develops hematogenous metastasis at an early stage, St. Jude staging is commonly used.

Stage I: single lymph node area or extra-nodal area, except for mediastinal and abdominal masses.

Stage II: single extranodal tumor with local lymph node involvement; 2 or more lymph node areas on the same side of the diaphragm; 2 separate extranodal tumors on the same side of the diaphragm with or without regional lymph node involvement; tumors originating in the gastrointestinal tract, often in the ileum with or without mesenteric lymph node involvement.

Stage IIR: both completely resected intra-abdominal lesions.

Stage III: Separate extranodal tumors on either side of the diaphragm; 2 or more lymphadenopathies on either side of the diaphragm; all tumors originating in the thoracic cavity (mediastinum, pleura, thymus); all extensive intra-abdominal lesions originating in the abdominal cavity that have not been completely resected; and all paraspinal or extradural masses, with or without involvement of other sites.

Stage IV: any of the above lesions plus CNS or bone marrow infiltration.

Differential Diagnosis

Diseases causing superficial lymph node enlargement

Diseases in this group generally present with enlarged superficial lymph nodes, similar to some lymphomas. When superficial lymph node enlargement is present, it is not always a lymphoma and in most cases it is one of the following diseases.

Acute lymphadenitis

There is usually localized redness, swelling, heat, and pain in the lymph nodes, the skin may be flushed, the lymph nodes are soft to moderately hard, there is spontaneous pain and tenderness on pressure, the surface is smooth, there are no adhesions, and it is associated with a primary infection focus.

In patients with lymphoma, the symptoms of enlarged superficial lymph nodes are progressively worse and are usually painless.

Pathohistologic examination helps to clarify the diagnosis.

Chronic lymphadenitis

Commonly, there are scattered enlarged lymph nodes in the lateral neck or submandibular region, which are about the size of green beans to fava beans, flat, medium-soft in texture, with smooth and movable surfaces. There may be light or no pressure pain.

If it is difficult to make a clear diagnosis for a while, antibiotic treatment can be tried, and if the lumps shrink significantly, lymphadenitis is more likely.

If necessary, needle aspiration cytology examination can be done, chronic inflammatory cells can be seen, and lymphadenitis can be diagnosed.

Lymph node metastatic cancer

When lymph node metastasis occurs in cancer, it can also lead to enlarged lymph nodes. For example, in breast cancer, there are often enlarged lymph nodes in the axilla of the same side.

However, patients usually have clinical manifestations of primary tumor lesions, and lymph node biopsy can help to identify them.

Other extranodal lymphomas

Other non-lymph node lymphomas usually require pathologic diagnosis to confirm the diagnosis, such as MALT lymphoma and DLBCL.

Treatment

Principles of treatment

Burkitt’s lymphoma is sensitive to chemotherapy, and treatment is based on chemotherapy, which may be combined with the use of targeted drugs. Surgery and radiotherapy can be used in specific cases.

Treatment Methods

Chemotherapy

Burkitt’s lymphoma is a kind of highly malignant and aggressive lymphoma, which requires the use of high-dose, short-course chemotherapy regimen, which is also the main and most effective means, and the most commonly used treatment regimens include Hyper-CVAD/MA, CODOX-M/IVAC, EPOCH regimen and so on.

Precautions

The chemotherapy regimen is determined by the doctor according to the patient’s specific condition. In general, chemotherapy regimens for Burkitt’s lymphoma are high-dose and short, but each course is more closely spaced.

Drug therapy, especially chemotherapy is cytotoxic drug therapy, the specific use of please refer to the diagnosis and treatment norms formulated by the National Health and Health Commission, NCCN guidelines, guidelines formulated by the Chinese Medical Association or the Chinese Medical Doctor’s Association, drug encyclopedia, etc., and the appropriate regimen must be selected under the guidance of the doctor and individualized treatment.

Adverse reactions and their treatment

Tumor lysis syndrome

Burkitt’s lymphoma is sensitive to chemotherapy, and if the tumor is highly loaded, after the initial treatment is administered, a large number of tumor cells will lysed and necrotic, and tumor lysis syndrome will occur.

Hyperphosphatemia, hyperkalemia, hyperuricemia, hypocalcemia, and acute kidney injury may occur.

It is mainly prevented by allopurinol, uric acid oxidase, and hydration therapy.

Liver damage

Chemotherapeutic drugs such as methotrexate are hepatotoxic and can present with elevated transaminases or bilirubin.

If liver damage is detected, the administration of the drug needs to be delayed according to the doctor’s advice.

The prophylactic use of all types of hepatoprotective drugs is not recommended.

Heart damage

Adriamycin belongs to the anthracycline group of drugs, which are cardiotoxic and can cause acute myocardial injury or chronic cardiac impairment.

Symptoms such as panic, chest tightness and shortness of breath may occur.

If heart damage is detected, your doctor will decide to temporarily discontinue the anthracycline or treat with other medications after evaluation.

Neurotoxicity

Vincristine: When nerve damage is caused, it may manifest as jaw pain, constipation, abdominal cramps, and numbness in the hands and feet. The doctor may adjust the medication.

Cytarabine: Doctors may adjust the dose of the drug when there are noticeable symptoms.

Nephrotoxicity

People who are co-infected with HIV often need to use drugs such as acyclovir, which are nephrotoxic and can cause abnormal kidney function.

If methotrexate is required at the same time, the medication needs to be delayed according to the doctor’s request.

Hematological toxicity

Chemotherapy drugs may cause a drop in the number of platelets and white blood cells.

Those with decreased white blood cell counts may require granulocyte colony-stimulating factor.

Those with decreased platelets may require blood transfusions.

Chemotherapy Care

Leukopenia: Infections can occur more easily when white blood cells are reduced. During chemotherapy, it is important to keep warm and rest, avoid catching a cold, and reduce the risk of infection by minimizing close contact with people.

Anorexia, nausea and vomiting: Eat small meals and eat easily digestible, light food. If necessary, consult your doctor if you need to take anti-emetic drugs.

Fever: For fever below 38℃, no antipyretic drugs can be used, drink plenty of warm water and pay attention to rest; if the body temperature exceeds 38℃ and there is obvious headache or general malaise, you should go to the hospital for follow-up in time.

Generalized fatigue: mostly related to anemia, need to rest and strengthen nutrition, intake of sufficient calories and protein can help relieve the discomfort. If necessary, ask your doctor if you need to take any medication to correct the anemia.

Targeted therapy

For CD20-positive Burkitt’s lymphoma, CD20 monoclonal antibody (rituximab) is used.

The risk of serious adverse reactions is elevated in those with a large tumor load.

Adverse reactions may include fever, chills, facial flushing, nausea, fatigue, headache, and pruritus; hematologic adverse reactions are less frequent and less severe and include thrombocytopenia, neutropenia, and anemia.

Surgery

Surgery can be used for resection of large masses and removal of material for histopathological examination, which can reduce the tumor load and enhance the effectiveness of chemotherapy and targeted therapy.

Surgery may be required for acute abdomen, hypersplenism with indication for splenectomy.

Some patients may undergo hematopoietic stem cell transplantation.

Radiation therapy

Burkitt’s lymphoma is usually not treated with radiation therapy; tumors in specific areas such as the nasopharynx may be amenable to radiation therapy.

Immunotherapy

Burkitt’s lymphoma may be treated with chimeric antigen receptor T-cell immunotherapy (CAR-T).

Prognosis

Cure

Survival

Burkitt’s lymphoma is a type of B-cell lymphoma, and B-cell lymphomas have a better prognosis in children with varying intensities of treatment depending on the level of risk.

The overall event-free survival (EFS) is about 90%; it is also higher than 70% for those who have stage IV or develop leukemia.

Event-free survival is defined as the proportion of all patients who do not experience the following events within a specific time frame; events include disease progression, change in chemotherapy regimen, occurrence of intolerance to treatment, and death.

Recurrence and Metastasis

Burkitt’s lymphoma is highly aggressive and prone to hematogenous metastasis.

After treatment, Burkitt’s lymphoma remains at risk for recurrence.

Prognostic Factors

Prognostic factors are factors that have an impact on the overall survival and quality of life of patients.

Prognostic factors for Burkitt’s lymphoma may include large tumor foci and high tumor load prior to treatment, LDH >1000 U/L, progressing children with central nervous system (CNS) invasion, poor response to early treatment, and failure to achieve a complete remission after 3 to 4 courses of therapy.

The prognosis may also be poor for those with rapidly progressing disease, stage IV at diagnosis, and residual tumor at midterm evaluation.

Hazards

Symptoms such as swelling and infiltration of Burkitt’s lymphoma can interfere with normal life.

The prognosis for Burkitt’s lymphoma may be poor and affect life expectancy.

Daily

Daily management

Psychological support

A good mood and mindset cannot be replaced by medications.

After diagnosis, patients may develop a sense of fear and may be afraid of pain, abandonment and death.

Family members should pay attention to listen to the patient’s heart, improve the patient’s psychological tolerance and relieve anxiety symptoms.

Encourage the patient’s family to give support so that the patient can face chemotherapy positively with a good mindset.

During the inter-treatment period and after the treatment, family members are advised to encourage the patient to do work and household chores that are within his/her ability to reintegrate into his/her social roles.

Life management

The living environment should be kept clean, with sufficient ventilation, sufficient sunlight and suitable temperature.

Disinfect the room regularly to avoid infection.

Maintain good hygiene and cleanliness, gargle with saline solution after meals and before bedtime, and use a soft-bristled toothbrush.

Pay attention to safety, avoid excessive activities and trauma for those who are prone to bleeding.

Dietary management

Balanced dietary structure, diversified food types and rich nutrition. Pickled, fried and deep-fried food should be avoided.

Eat more vitamin-rich vegetables and fruits, such as broccoli, tomatoes, celery, lettuce, kiwi, apples and bananas.

Eat more protein-rich foods, such as eggs, milk, lean meat and fish.

It is recommended not to eat foods that stimulate the secretion of stomach acid, such as foods that are too sweet and spicy.

Activity management

Pay attention to rest, avoid staying up late or straining, and ensure sufficient sleep and rest to reduce physical exertion and promote recovery.

When the condition improves, start with low intensity exercise such as walking and gradually resume normal activities.

Follow-up and review

Pay attention to monitoring the condition, regular follow-up, and consult the doctor promptly if fatigue, fever, night sweats, emaciation, and lymph node enlargement occur.

Follow-up can refer to the recommended standards of Lugano Conference 2014, please follow the doctor’s instructions.

Follow-up content

Medical history, physical examination, routine laboratory tests, imaging tests.

The physician will consider chest X-ray, ultrasound, CT or MRI depending on the patient’s condition and the duration of the follow-up visit.

PET-CT is usually not recommended as a follow-up examination.

Follow-up frequency

In general, for the first 2 years after completion of treatment, follow-up is every 3 months.

Thereafter, every 6 months for up to 5 years.

Thereafter, it is repeated annually for the rest of your life.

Prevention

There is no standard prevention protocol for lymphoma, including Burkitt’s lymphoma, but attention to the following may help reduce the incidence of lymphoma, including Burkitt’s lymphoma.

Improve child health care

Immunize infants and children on schedule.

Develop the habit of exercising at an early age to strengthen the body.

Wash hands before and after meals; avoid gathering and wear masks during the season of respiratory diseases; prevent invasion of various viruses and bacteria.

Enhance the resistance of the immune system

Eat a well-balanced diet with three regular meals to prevent malnutrition.

Reasonable use of medication, avoid the abuse of antibiotics, use corticosteroid drugs under the guidance of a doctor.

Adopt good living habits, enhance physical exercise, quit smoking and drinking, and avoid staying up late.

Avoid spicy, stimulating food, eat less fried and fatty food.

Pay attention to warmth and personal hygiene to avoid viral infections.

Improve lifestyle

Purify the living environment and stay away from radiation and pollution, which tend to denature lymphocytes, so the decoration of houses emphasizes the use of environmentally friendly materials.

Avoid exposure to ionizing radiation.

Early detection and treatment

People with family genetic tendency need regular medical checkups for early detection and treatment.

Timely treatment of certain chronic diseases of the body and improvement of the body’s immune function.