Burkitt lymphoma is an aggressive non-Hodgkin's B-cell lymphoma. The disease is associated with Epstein-Barr virus, human immunodeficiency virus (HIV), and chromosomal translocations. The WHO divides Burkitt lymphoma into three clinical groups: endemic, sporadic, and immunodeficiency associated. In developed countries, most patients can be cured of the disease. Doctors use modern chemotherapy regimens, immunotherapy, and in severe cases, a stem cell transplant may be a treatment option to choose.
Diagnosis:
The following examinations can be used for diagnosing Burkitt 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:
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:
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.
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:
In patients with recurrent Burkitt lymphoma, doctors use rescue regimens:
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.
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:
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:
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:
Required documents
Price from: on request
Type of program: Inpatient
Expected duration of the program: 6 days
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2-Chemotherapy:
The program includes:
Required documents
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:
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
Price from: on request
Type of program: Inpatient
Expected duration of the program: 57 days
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