Burkitt lymphoma

Burkitt lymphoma (BL) is a rare type of non-Hodgkin lymphoma (NHL) that affects children and adults. BL develops when the body makes abnormal B-cells – the lymphoma cells. B-cells are white blood cells that fight infection.

BL may cause a lump in the tummy area, which can cause pain, swelling, nausea and diarrhoea. It can also cause painless swellings in the neck, armpit or groin. Other symptoms may include:

  • night sweats
  • high temperatures
  • weight loss
  • tiredness.

To diagnose BL, a doctor removes a sample of tissue (biopsy). You will also have tests to find out more about the lymphoma and to help plan your treatment.

The main treatment for BL is targeted therapy, chemotherapy and steroids. You stay in hospital during your treatment. This is because:

  • it takes several hours to give the drugs
  • you have extra treatments to prevent side effects
  • you are monitored for side effects which may need to be treated quickly.

You may be invited to take part in a clinical trial looking at new ways of treating BL. You can talk about this with your lymphoma doctor.

What is Burkitt lymphoma (BL)?

It is best to read this information with our general information about non-Hodgkin lymphoma (NHL). If you have any more questions, you can ask your doctor or nurse at the hospital where you are having treatment.

This information is about Burkitt lymphoma in adults. Burkitt lymphoma can also affect children. If you need more information about lymphoma in children, you can contact the Children’s Cancer and Leukaemia Group.

Burkitt lymphoma (BL) is a rare type of fast-growing NHL. It develops when B-cells (also called B-lymphocytes) become abnormal. B-cells are white blood cells that fight infection.


Causes and risk factors for BL

There are different types of BL. The most common type in the UK is often called sporadic BL. In most cases the cause of this type is unknown. Like other cancers, it is not infectious and cannot be passed on to other people. But some things may increase the risk of developing it.

People with a weakened immune system may have a higher risk of BL. The body’s immune system can be weakened by:


Signs and symptoms of BL

BL may cause a lump or mass in the tummy area (abdomen). This can cause pain and swelling, feeling sick (nausea) and diarrhoea.

It may also cause painless swellings in the neck, armpit or groin. This is caused by lymphoma cells building up in the lymph nodes, which makes them bigger. Often lymph nodes in more than one part of the body are affected. If BL is in lymph nodes in the chest, throat or jaw, this may cause a sore throat, difficulty swallowing or breathlessness.

General symptoms may include loss of appetite and tiredness.

B symptoms

Some people also have:

  • drenching night sweats
  • high temperatures (fevers) with no obvious cause
  • unexplained weight loss.

These are called B symptoms.


Diagnosing lymphoma

The most common test for this lymphoma is to remove part or all of an enlarged lymph node (a biopsy). This may be done under local or general anaesthetic. The biopsy is then sent to a laboratory to be checked for lymphoma cells. You may also have biopsies taken from other areas of the body.

You may have some other tests, such as:

  • blood tests
  • x-rays and scans
  • bone marrow samples
  • a lumbar puncture.

Doctors use the information from all these tests to find out more about the lymphoma, such as its stage and grade.


Staging and grading BL

Staging

The stage of the lymphoma describes which areas of the body are affected by lymphoma. This information helps doctors plan the right treatment for you.

The stage of a lymphoma is usually described using numbers from 1 to 4. Stages 1 and 2 are also called early-stage, limited or localised lymphoma. Stages 3 and 4 are also called advanced lymphoma.

As well as giving each stage a number, doctors often add the letters A or B. A means you do not have B symptoms. B means you do have B symptoms.

Sometimes the lymphoma can affect areas outside the lymph nodes. This is called extranodal lymphoma, and the stage will include the letter E (for extranodal).

Grading

Non-Hodgkin lymphomas are divided into two groups:

  • Low-grade (indolent) lymphomas, which usually grow slowly.
  • High-grade (aggressive) lymphomas, which grow more quickly.

BL is a high-grade, fast-growing lymphoma.


Treating BL

The main treatment for BL is a combination of drugs that includes targeted therapy, chemotherapy and steroids. You usually stay in hospital while you are having this treatment. This is because:

  • it takes several hours to give the drugs
  • you will have extra treatments to prevent side effects
  • you will be monitored closely for side effects, such as tumour lysis syndrome, which may need to be treated quickly.

Treatment for BL may cause the lymphoma cells to break down very quickly. This can cause chemical imbalances in the blood that affect the kidneys and the heart. This is called tumour lysis syndrome (TLS).

You doctor and nurse will monitor you closely for signs of TLS and give you drugs to help prevent it. You usually have a drug called rasburicase as a drip (infusion) and extra fluids as a drip to help protect your kidneys. You may only need rasburicase with the first treatment for BL. After that, you can have tablets called allopurinol instead.

Rituximab

The drug rituximab is often used with chemotherapy to treat this type of lymphoma. It works by targeting proteins on the surface of B-cell lymphocytes. This makes the body destroy these cells.

Rituximab is given as a drip into a vein or an injection under the skin.

Chemotherapy

Chemotherapy is the use of anti-cancer drugs to destroy cancer cells.

The combination of drugs you have will depend on the stage of the lymphoma and your general health. The chemotherapy drugs are given into a vein (intravenously). The following drugs may be used in different combinations to treat BL:

Your lymphoma doctor will talk to you about the combination of drugs you will have.

Chemotherapy can also be given into the spinal fluid to allow the drug to reach the spinal cord and brain (central nervous system). This is called intrathecal chemotherapy. It may be given to treat lymphoma or to reduce the risk of lymphoma developing in these areas.

Steroids

Steroids are drugs that are often given with chemotherapy to treat lymphomas. They help make chemotherapy more effective. They also help you feel better and can reduce feelings of sickness.


Clinical trials

Your lymphoma doctor may talk to you about having treatment as part of a clinical trial. Clinical trials test new treatments or new ways of giving treatments.


Follow-up after treatment

After treatment, you will have regular check-ups. These appointments are a good opportunity for you to talk to your doctor or nurse about any concerns you have. Your doctor will want to know how you are feeling generally, and to check you are recovering from any side effects of treatment. We have more information about follow-up.


Getting support

Everyone has their own way of dealing with illness and the different emotions they experience. You may find it helpful to talk things over with family and friends or your doctor or nurse. You can also call our cancer support specialists free on 0808 808 00 00. The organisations below also offer information and support:

  • Bloodwise offers support and information to people affected by blood cancers, including lymphoma.
  • The Lymphoma Association gives emotional support, advice and information on all aspects of Hodgkin lymphoma and non-Hodgkin lymphoma. It has a national network of people with lymphoma, and local groups.