Burkitt's lymphoma

 Reference: ERN Blood Net Lancet Hematology Feb 2025

BL-IPI

• age > 40yr, 
• LDH > ULN
• ECOG 2 or higher
• CNS involvement

Initial diagnosis: excision or bx, fluid or bone marrow aspirate, cytogenetics or FISH ( t ( 8;14) in Burkitt's as opposed to t (14;18) in Follicular.

• EBV and SOX 11 testing on all cases. Then, based on the findings, you divide Burkitt's into 3 groups.
• Initial testing: CBC, CMP, phosphate, uric acid, viral serology, EBV PCR, CT. PET not required. MRI if neurologic symptoms.
• Evaluate risk factors for TLS: Circulating Burkitt cells, serum LDH, bulky disease > 7 cm, bone marrow involvement, III or IV stage, ECOG 2 or higher, Cr Cl < 80

If 1 or more factors present start TLS prophylaxis immediately.

• Prevention include: hydration 2-3 liters/m2 per 24 hr
• Rasburicase
• If person may have G6PD def--> start allopurinol, send G6PD testing before starting rasburicase

First line rx:

Has to include anthracycline.

High risk: ECOC 2 or higher, Ann Arbor III or IV stage, LDH > ULN, tumor > 7 cm

R CODOX/MIVAC

DA R EPOCH with CNS prophylaxis

Low risk 3-6 cycles DA-R EPOCH or 3 cycles CODOX R-M

Prophylaxis:

PJP

Acyclovir

Reference: BCCA https://www.bccancer.bc.ca/chemotherapy-protocols-site/Documents/Lymphoma-Myeloma/LYCODOXMR_Protocol.pdf