Diagnosis:

 The following examinations can be used for diagnosing Burkitt lymphoma:

• methods of medical imaging to assess the spread of the tumor process and to establish the stage of the disease,
• a biopsy with a histological examination of the material obtained in order to confirm the type of lymphoma.

To diagnose the early stages of the disease in adult patients, doctors use computed tomography (CT) of the chest, abdomen, and pelvis. Children undergo a chest X-ray, ultrasound scanning of the pelvis and abdomen, as well as a CT scan of the chest, abdomen, and pelvis. Depending on the clinical picture, some patients may require a contrast-enhanced MRI of the neck and brain too. A PET/CT scan can only be conducted for a suspected recurrence or when there is resistance to therapy.

During the course of treatment, diagnostic tests are repeated several times. This is necessary for measuring the tumor foci and assessing a patient's response to treatment, as well as for an early detection of tumor recurrence.

Diagnosis confirmation methods include:

• lymph node biopsy, which aims to completely remove one of the superficially located lymph nodes for its examination;
• lumbar puncture (cerebrospinal fluid analysis), which is used to check if the tumor has spread to the central nervous system;
• Bone marrow biopsy, which can confirm or exclude the spread of Burkitt lymphoma to the bone marrow.

At the time of diagnosis, the central nervous system is involved in about 15% of patients. In 30% of cases, doctors find signs of bone marrow involvement. Bone marrow lesions can sometimes dominate, and such cases of the disease are called Burkitt leukemia.

Doctors carry out the diagnostics as quickly as possible, since the timing of treatment is very important for the successful overcoming of the disease. The therapy begins within 48 hours after the establishment of a diagnosis. If you want to get medical care abroad as quickly as possible, the Booking Health service will be very helpful for you. Our specialists will help you to negotiate with the administration of the clinic to reduce the waiting period before the start of your treatment.

 

Treatment of early stages

 For some early-stage non-Hodgkin's lymphomas, surgery or radiation therapy is recommended alone or in combination with chemotherapy. However, in Burkitt lymphoma, this tactic is not used for the two following reasons:

• most patients respond to chemotherapy, so there is no need to remove or irradiate the tumor;
• Neither surgery nor radiation therapy can allow patients to avoid subsequent chemotherapy – since the tumor is very aggressive, it can recur after its local treatment if systemic drug therapy is not additionally provided.

Therefore, radiation therapy for Burkitt lymphoma is almost never used. Surgery can sometimes be used when complications develop for example, if a tumor in the abdominal cavity has caused a bowel obstruction.

• Chemotherapy

In developed countries, 90% of children and young people are cured of sporadic Burkitt lymphoma. The treatment regimen depends on the age of the patient and the stage of the disease.

Should surgery be performed to completely remove the tumor, then it will be followed by two cycles of moderate-intensity chemotherapy. At stages 1-2 of the disease, success is achieved in 98% of cases.

Intrathecal therapy is carried out simultaneously with systemic chemotherapy. This means that drugs are injected into the cerebrospinal fluid through a lumbar puncture.

In adult patients, the principles of treatment are similar, but doctors use different regimens:

• R-Hyper-CVAD.
• CODOX-M/IVAC.
• EPOCH.

In patients with recurrent Burkitt lymphoma, doctors use rescue regimens:

• R-IVAC.
• R-GDP.
• R-ICE.
• DHAP.

Highly active antiretroviral therapy has no direct antitumor effect, but is prescribed to all patients with HIV, as it allows doctors to conduct a more successful treatment of Burkitt lymphoma associated with immunodeficiency. Physicians are able to safely use high-intensity chemotherapy. Without antiretroviral therapy, less toxic chemotherapy would have to be used in this patient population, due to their lack of immune cells and susceptibility to infectious complications.

• Immunotherapy and targeted therapy

 Monoclonal antibodies that target CD20 antigens are an essential component of any treatment regimen in developed countries. Other drugs are used much less frequently. Some drugs are still undergoing clinical trials for Burkitt lymphoma. These include:

• CD19 and CD22 monoclonal antibodies.
• mTOR inhibitors.
• immune checkpoint inhibitors (PD1 inhibitors).

• Stem cell transplant

 Since most people with Burkitt lymphoma are children and young adults, many of them are candidates for stem cell transplants. The need for this procedure occurs infrequently, since the disease can usually be cured with the help of drugs. But, in some patients, the tumor does not completely disappear or it recurs after its initial treatment, forcing doctors to use more effective tools in their fight against Burkitt lymphoma.

There are two options for stem cell transplant:

• Autologous.
• allogenic.

An autologous transplant involves the use of the patient's own stem cells. These are harvested in advance from the patient’s blood or bone marrow and then high-dose chemotherapy is given. This can be supplemented with total body irradiation. High doses of drugs destroy all Burkitt lymphoma cells, but irreversibly suppress the bone marrow too. To restore its function, doctors inject the patient with the previously harvested stem cells. After a few weeks, the work of the hematopoietic system is restored. The therapeutic effect is provided by high doses of drugs that are used before the transplant procedure. Although Burkitt lymphoma may recur in the future, the procedure usually provides long-term remission.

An allogeneic transplant involves the transplantation of stem cells from a donor. The donor can be a brother or a sister, these relatives have a 25% probability of being a full antigen match. Stem cells from an unrelated donor can be used as well. This treatment option for Burkitt lymphoma is even more effective, but more likely to cause complications. A donor’s bone marrow may be rejected by the patient's immune system or attack the patient's own body if the antigen compatibility is incomplete. However, if the procedure is successful, the new bone marrow produces white blood cells that attack the Burkitt lymphoma cells and can completely cure the cancer. This reaction is called graft-versus-tumor.

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1-Diagnosis:

The program includes:

• Initial presentation in the clinic
• clinical history taking
• review of medical records
• physical examination
• laboratory tests:
• complete blood count
• biochemical blood test
• inflammation markers (CRP, ESR)
• blood coagulation analysis (aPTT, PT, INR)
• differential blood count
• ultrasound of the abdomen, CT/MRI / PET scans (if clinically indicated)
• bone marrow aspiration and biopsy (if clinically indicated)
• histological study
• immunohistochemical study
• cytogenetic analysis (Philadelphia chromosome detection)
• biopsy and histological examination of CSF (if clinically indicated)
• biopsy of lymphatic nodes with histopathology and immunohistochemistry (if indicated clinically)
• tumor board: consultation of medical oncology, radiology and radiation therapy specialists
• examination by related specialists (if clinically indicated):
• cardiologist
• otolaryngologist
• immunologist
• infectious diseases.
• nursing services
• explanation of future recommendations

Required documents

• Medical records
• MRI/CT scan (not older than 3 months)
• Bone marrow biopsy results (if available)

Price from: on request

Type of program: Inpatient

Expected duration of the program: 6 days

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2-Chemotherapy:

The program includes:

• Initial presentation in the clinic
• case history collection
• general clinical examination
• laboratory tests:
• complete blood count
• biochemical analysis of blood
• TSH-basal, fT3, fT4
• differential blood count
• inflammation indicators (CRP, ESR)
• indicators blood coagulation
• CT/MRI / PET scans (if indicated clinically)
• bone marrow aspiration and biopsy (if clinically indicated)
• biopsy of lymphatic nodes with histopathology and immunohistochemistry (if indicated clinically)
• biopsy and histological examination of CSF
• examination by experts of:
• cardiology
• otolaryngology
• immunology
• ophthalmology
• one cycle of chemotherapy
• symptomatic treatment
• control examinations
• the cost of essential medicines and materials
• nursing services
• tumor board: consultation of medical oncology, radiology and radiation therapy specialists
• full hospital accommodation
• explanation of future recommendations

Required documents

• Medical records
• MRI/CT scan, PET scan (not older than 3 months)
• Lymph node or Bone marrow biopsy results (if available)

Price from: on request

Type of program: Inpatient or outpatient (related to your diagnosis and treatment protocol).

Expected duration of the program: may differ and be related to your diagnosis and treatment protocol.

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3-Bone marrow transplantation:

The program includes:

• Initial presentation in the clinic
• case history collection
• general clinical examination
• laboratory tests:
• complete blood count
• general urine analysis
• biochemical analysis of blood
• TSH-basal, fT3, fT4
• tumor markers
• indicators of inflammation
• indicators of blood coagulation
• CT/MRI scans of the whole body
• needle biopsy of the bone marrow
• biopsy and histological examination of CSF (if indicated clinically)
• examination by experts of:
• Cardiology
• Otolaryngology
• Immunology
• Ophthalmology
• Infectious disease
• conducting high-dose chemotherapy or radiotherapy (for destruction of all marrow cells).
• CT simulation and Physics calculations
• autologous bone marrow transplantation
• isolation by neutropenic precautions in transplantation unit
• symptomatic treatment
• the cost of essential medicines and blood products
• nursing services
• stay in the hospital with full board
• elaboration of further recommendations

How program is carried out

During the first visit, the doctor will conduct a clinical examination and go through the results of the available diagnostic tests. After that, you will undergo the necessary additional examination, such as the assessment of liver and kidney function, ultrasound scan, CT scan and MRI.

Also, the doctor will conduct a bone marrow biopsy followed by cytological examination of the harvested material. This will help him to determine the histological features of your bone marrow (in particular, identify HLA system antigens) and the use of a person’s own stem cells. They typically involve harvesting your cells before beginning a damaging therapy to cells like chemotherapy or radiation. After the treatment is done, your own cells are returned to your body.

This type of transplant isn’t always available. It can only be used if you have a healthy bone marrow. However, it reduces the risk of some serious complications, including GVHD.

 

Before the procedure, you will receive chemotherapy, if necessary, in combination with radiation therapy. The course of chemo- or chemoradiation therapy lasts from 2 to 8 days.

The bone marrow transplant procedure is an intravenous infusion, i.e. the healthy bone marrow will be injected through a catheter, intravenously. You will stay in your room during the procedure. A bone marrow transplant is completely painless and does not require anesthesia.

 

During the period of healthy bone marrow engraftment, you will stay in a sterile ward. This is a necessary precaution because during this time your immune system is very weak and cannot withstand environmental pathogens. The risk of bleeding is also quite high, so you will be advised to avoid mechanical damage.

 

A relative or other close person may stay in the ward with you. You will not be allowed to go outside the department and leave your ward often. The rehabilitation period can last from 1 to 2 months.

When your complete blood count returns to normal, your doctor will schedule your discharge from the department. You will receive information about the rules that you will need to follow at home, the frequency and type of control examinations, and subsequent treatment measures. You will also receive a detailed medical report, which will reflect the entire course of treatment.

 

Required documents

• Medical records
• MRI/CT scan (not older than 3 months)
• Bone marrow biopsy results (if available)

Price from: on request

Type of program: Inpatient

Expected duration of the program: 57 days