Burkitt Lymphoma — A Medical Emergency That Needs Fast, Intensive Treatment

Diagnosis and urgency

Biopsy with immunohistochemistry shows a germinal-centre phenotype with near-100% Ki-67 and MYC rearrangement. Staging includes imaging, bone marrow and cerebrospinal fluid assessment. Tumour lysis risk is assessed before treatment, and prophylaxis with hydration, allopurinol or rasburicase is started early. Patients with bulky disease or renal impairment need urgent coordination.

• Urgent biopsy with Ki-67 and MYC rearrangement
• Staging imaging, bone marrow and CSF assessment
• Tumour lysis risk assessment and prophylaxis
• Electrolyte and renal monitoring
• Fertility and infection counselling before intensive therapy

Treatment

Burkitt lymphoma is treated with intensive multi-agent chemoimmunotherapy with CNS prophylaxis. Regimen intensity is adapted to age, fitness and HIV status. Response assessment is usually PET-CT. Relapsed disease is difficult to treat and may be considered for clinical trials, transplant or cellular therapy. Supportive care and early toxicity management are as important as the chemotherapy itself.

• Intensive multi-agent chemoimmunotherapy
• CNS prophylaxis
• HIV testing and coordinated care where positive
• PET-CT response assessment
• Clinical trials or transplant for relapsed disease

Guidelines referenced:

• NCCN Guidelines — B-Cell Lymphomas
• ESMO Clinical Practice Guidelines — Burkitt Lymphoma
• Lugano classification for staging and response