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 ​lymphocytes​ . It is a cancer of the ​lymphatic system​ . 

Burkitt lymphoma is fast growing (high grade). You have treatment soon after diagnosis. Treatment usually includes ​chemotherapy​ together with a ​targeted drug​ called rituximab. Doctors call this chemoimmunotherapy.

This page is about Burkitt lymphoma in adults. 

Read about NHL in children

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.

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 

Read about the different treatments for NHL

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 ​cycle​ . 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).

Go to our A-Z list of cancer drugs to read about the different drugs

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 ​lumbar puncture​ .

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.

Read more about intrathecal chemotherapy

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 ​remission​ after chemoimmunotherapy.

Read more about stem cell transplants

Radiotherapy

You might have radiotherapy to relieve symptoms if your lymphoma is pressing on an organ. Or if it is causing a blockage (obstruction).

Read about having radiotherapy

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.

Research

Researchers around the world are looking at the treatments for NHL. Your doctor might suggest you take part in a clinical trial. 

Read more about research into NHL