Burkitt lymphoma is a type of non-Hodgkin lymphoma (NHL). NHL is a cancer of the lymphatic system.
It develops when the body makes abnormal B lymphocytes. These lymphocytes are a type of white blood cell that normally help to fight infections. When you have a lymphoma, the abnormal lymphocytes build up in lymph nodes or other body organs.
Burkitt lymphoma grows quickly and your treatment starts soon after diagnosis.
The 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.
When you have lymphoma, some of your white blood cells (lymphocytes) don't work properly. They start to divide constantly but don't develop fully. So they can't fight infection as normal white blood cells do.
There are different types of NHL. The type you have depends on several factors including the type of cell it starts in and how fast growing it is.
There are two main types of lymphocytes – B cells and T cells. They both help us fight infections but in slightly different ways.
Burkitt lymphoma affects the B cells and so is called a B cell lymphoma.
How common is it?
Each year around 210 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. These types refer to the cause of the disease and where they are more common in the world.
Sporadic Burkitt lymphoma
This is the most common type of Burkitt lymphoma in the UK.
Sporadic Burkitt lymphoma is linked to a virus called the Epstein-Barr virus (EBV). This is the virus that causes glandular fever (mononucleosis). People who have had mononucleosis might have a higher risk of developing NHL.
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 of Burkitt lymphoma can develop in people who 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.
The information in this section is mainly about sporadic and immunodeficiency-related Burkitt lymphoma.
These are symptoms of sporadic and immunodeficiency-related Burkitt lymphoma:
The most common symptom is one or more painless swellings. They can grow very quickly. These swellings are enlarged lymph nodes.
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. Some people may also have unexplained itching. It is important to tell your doctor about any symptoms like this.
Lymphoma in the abdomen
Burkitt lymphoma often grows in the tummy (abdomen) and bowel. You might have some of the following symptoms:
- tummy (abdominal) or back pain
- feeling or being sick
- swelling of your tummy (abdomen) as fluid collects
- bleeding and pain from a bowel blockage (obstruction)
Lymphoma in the bone marrow
Bone marrow is spongy tissue and fluid that is inside your bones. It makes your blood cells.
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
The symptoms of Burkitt lymphoma can start or get worse in just a few days.
The main tests are:
- removal of the enlarged lymph node, or taking a sample of tissue from a lymph node (lymph node biopsy)
- blood tests
You have other tests if lymphoma cells are found in the biopsy. You might have different scans and a bone marrow test.
Stages and grades
Doctors put NHL into 2 groups, depending on how quickly they are likely to grow and spread. The 2 groups are:
• low grade (slow growing)
• high grade (fast growing)
Burkitt lymphoma is fast growing and is called a high grade lymphoma.
Your stage means the number and position of lymph nodes or other organs affected by lymphoma.
There are different staging systems for adults and children with Burkitt lymphoma.
The Lugano classification is used to stage NHL in adults, including Burkitt lymphoma.
If your child has Burkitt lymphoma, ask your specialist to explain their stage.
Treatment aims and decisions
The aim of treatment for Burkitt lymphoma might be to:
- cure the lymphoma
- control the lymphoma for as long as possible
- control symptoms
- stop lymphoma spreading to other parts of the body, such as the fluid around the brain and spinal cord (cerebrospinal fluid)
- stop lymphoma coming back
Talk to your doctor or specialist nurse if you want to find out more about the aim of treatment. This could be different for different people with Burkitt lymphoma.
As Burkitt lymphoma is fast growing (high grade) 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 would usually then have more treatment.
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
Sporadic and immunodeficiency related Burkitt lymphoma are treated in the same way.
Chemotherapy and immunotherapy
Burkitt lymphoma is usually treated with a number of different chemotherapy drugs and a targeted immunotherapy drug called rituximab (Mabthera). You might hear this combination called chemoimmunotherapy.
Your treatment can be very intensive lasting several months. You might be in hospital for a lot of this time.
There are different drug combinations. You might have a different combination to the examples listed here.
Drug combinations for Burkitt lymphoma include:
- R-CODOX-M (rituximab, cyclophosphamide, vincristine, doxorubicin, and methotrexate)
- R-IVAC (rituximab, ifosfamide, etoposide, cytarabine)
- R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone)
- DA-EPOCH-R (rituximab with dose adjusted etoposide, prednisolone, vincristine, cyclophosphamide and doxorubicin)
Chemotherapy to stop spread to the brain
Some types of lymphoma (including Burkitt lymphoma) are more likely to spread to the brain and spinal cord (central nervous system). In certain situations, your doctor might want you to have treatment to prevent this.
The most common treatment is to have injections of the chemotherapy drug methotrexate into the fluid around your spinal cord. Or your doctor might suggest you have a high dose of methotrexate injected into your vein instead.
You might have this preventative treatment if you have NHL in:
- the space behind your nose (paranasal sinuses)
- your testicles
- your bone marrow
- the breast
Chemotherapy into the fluid that circulates around the brain and spinal cord is called intrathecal chemotherapy. It is very similar to having a lumbar puncture.
It is unusual to have surgery as part of your treatment for Burkitt lymphoma.
You might have surgery to relieve symptoms if your lymphoma is pressing on an organ, causing a blockage (obstruction).
You might have radiotherapy:
- to relieve symptoms if your lymphoma is pressing on an organ, causing a blockage (obstruction)
- before a stem cell or bone marrow transplant
You have regular follow up appointments after finishing treatment. For example, these might be every 3 months for about 2 years.
At these appointments, your doctor will examine you and ask about side effects. You usually have blood tests. Take the opportunity to ask any questions.
Contact your team if you have symptoms or other concerns in between these times. Don’t wait for a booked appointment.
There is research looking at the best way to treat non-Hodgkin lymphoma.
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.
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