Burkitt's lymphoma

Summarize

1. General

Burkitt's lymphoma is the most common type of malignant lymphoma in children, with a rapid onset, rapid progression, aggressiveness and malignancy.

The main manifestations are enlargement of superficial lymph nodes, maxillofacial and gingival masses, abdominal masses, intestinal volvulus, invasion of the kidneys, ovaries, bone marrow and central nervous system.

The modern standard treatment strategy for Burkitt's lymphoma is to use chemotherapy regimens of varying intensities based on tumor clinical stage and risk stratification.

On the basis of modern standardized diagnosis and treatment, the 5-year event-free survival rate of Burkitt's lymphoma patients reaches more than 80%, 95% to 100% in the low-risk group, 85% to 90% in the intermediate-risk group, and up to 80% in the high-risk group as well.

2. Definition of disease

Burkitt lymphoma, a subtype of non-Hodgkin lymphoma (non-Hodgkin lymphoma), originates from mature B lymphocytes and is a highly aggressive mature B-cell non-Hodgkin lymphoma.

Epidemiological

epidemiological

U.S. statistics estimate the incidence of Burkitt's lymphoma in the United States to be approximately 4 cases per million population per year, accounting for 40% of non-Hodgkin's lymphomas in children. It is highly prevalent between the ages of 4 and 14 years, most commonly between the ages of 4 and 6 years, and is most common in boys, being several times more common than in girls at all ages.

Etiolog & Risk factors

1. General

Burkitt's lymphoma is primarily caused by non-hereditary genetic mutations, and both congenital and acquired immunodeficiency syndromes may increase its risk.

2. Underlying causes

Burkitt's lymphoma has characteristic chromosomal variants, usually t(8;14)(q24;q32) chromosomal rearrangements, and in rare cases t(8;22)(q24;q11) and t(2;8)(q12;q24) chromosomal rearrangements may also occur. These chromosomal variants result in changes in the location of the C-MYC gene on the chromosome and affect its function. Since the C-MYC gene regulates cell division and proliferation, its mutation leads to uncontrolled cell proliferation. At the same time, variants such as BCL2/BCL6 gene rearrangement, deletion of 13q, 1q duplication and 6q deletion may also occur in Burkitt's lymphoma, which together lead to uncontrolled malignant proliferation of cells and development of tumors.

3. Predisposing factors

1) Congenital and acquired immunodeficiency syndromes

● Innate immunodeficiencies: e.g., common variable immunodeficiency disease, eczematous thrombocytopenia with immunodeficiency syndrome (Wiskott-Aidrich syndrome), ataxia telangiectasia, and X-linked lymphoid hyperplasia syndrome have been associated with the development of Hodgkin's lymphoma.

:: Acquired immunodeficiencies, such as AIDS and acquired immunodeficiencies caused by bone marrow transplantation or organ transplantation, also increase the risk of Burkitt's lymphoma.

2) EBV infection

EBV infection may also induce Burkitt's lymphoma, which is more common in Africa.

Classification & Stage

Type of disease

1) Disease typing

Three different clinical types of Burkitt's lymphoma exist:

●Endemic Burkitt's lymphoma: most common in Central Africa, associated with EBV infection, mostly presenting as a mass in the jaw or face, but may also involve extranodal sites such as the mesentery, ovaries, testes, kidneys, breasts, and meninges.

:: Sporadic Burkitt's lymphoma: also known as non-endemic Burkitt's lymphoma, it can be seen worldwide and is the most common type in China. It usually occurs in the abdomen and may be accompanied by a large mass and ascites, which may manifest as intestinal obstruction, intussusception, or perforation of the gastrointestinal tract. The tumor may involve the terminal ileum, stomach, cecum, mesentery, kidneys, ovaries, testes, breasts, bone marrow, or central nervous system.

:: Immunodeficiency-associated Burkitt's lymphoma: these patients are associated with congenital or acquired immunodeficiencies, such as children with AIDS, hematopoietic stem cell transplants or solid organ transplants. These tumors often involve lymph nodes, bone marrow, and the central nervous system; extensive bone marrow involvement may present with signs and symptoms of leukemia, known as Burkitt's leukemia.

2) Disease Staging

The staging criteria for Burkitt's lymphoma is the Revised International Pediatric NHL Staging System (IPNHLSS):

● Phase I

A single tumor (lymph node, extranodal bone, or skin), except for mediastinal or abdominal lesions.

● Phase II

Single extranodal tumor with regional lymph node invasion;

Regional invasion of ≥2 lymph nodes ipsilateral to the diaphragm;

Primary tumor of the gastrointestinal tract (often in the ileum) ± associated mesenteric lymph node involvement with complete tumor resection;

If accompanied by malignant ascites or tumor spread to adjacent organs should be designated as stage III.

● Phase III

≥2 extranodal tumors (including extranodal bone or extranodal skin) above and/or below the diaphragm;

Regional invasion of ≥2 lymph nodes above and below the diaphragm;

Any intrathoracic tumor (mediastinal, hilar, pulmonary, pleural, or thymic) intra-abdominal or retroperitoneal lesion, including liver, spleen, kidney, and/or ovary, without regard to resection;

Any paraspinal or extradural lesion located without regard to the presence or absence of lesions elsewhere;

Single bone lesions with concomitant extra-nodal invasion and/or non-regional lymph node invasion.

● Phase IV

Any of the above lesions accompanied by CNS invasion (stage IV CNS), bone marrow invasion (stage IV BM) or central and bone marrow invasion (stage IV BM+CNS) could be detected using conventional morphologic methods.

3) Disease Risk Grouping

Burkitt's lymphoma has different ways of grouping risk levels depending on treatment options.

i) LMB Collaborative Group Program Hazard Grouping

The LMB Collaborative Group program is divided into the following three groups according to risk, from low to high:

● Group A:

Stage I-II with complete resection.

:: Group B:

Incompletely resected stage I-II;

Stage III-IV without CNS invasion and <25% tumor cells in bone marrow.

● Group C:

Tumor cells >25% in bone marrow;

Presence of large tumor foci (single tumor foci >10 cm in diameter or >4 organs infiltrated);

Presence of CNS and/or testicular invasion;

Poor early treatment response (<25% tumor shrinkage on day 7 of COP regimen chemotherapy and/or presence of residual lesions on mid-term assessment) in groups A and B.

ii) BFM95 Program Hazard Grouping

The BF M95 program is grouped from low to high risk based on:

● Group R1:

Stage I and II tumors were completely resected.

● Group R2:

Stage I and II tumors were not completely resected.

Stage III and LDH <500 U/L.

● Group R3:

Stage III and an LDH of 500 to 1000 U/L.

Stage IV without CNS invasion and LDH <1000 U/L.

● Group R4:

Stage III or IV with LDH >= 1000 U/L with or without CNS invasion.

Clinical manifestations

1. General

Most Burkitt's lymphomas have a rapid onset and progression. Clinical manifestations vary depending on the area of involvement, and may present as enlarged lymph nodes, maxillofacial swelling, or acute abdominal symptoms due to an abdominal mass, and may rapidly develop bone marrow metastases with leukemia-like symptoms.

In China, sporadic Burkitt's lymphoma is more common, often occurring in the abdomen or head and neck, with a few patients experiencing invasion of the bone marrow and central nervous system.

2. Typical symptoms

● Enlargement of superficial lymph nodes;

● Tumors of the jaw or gums or face that may lead to oropharyngeal filling and respiratory tract compression;

● Abdominal pain, vomiting, intussusception, intestinal obstruction, gastrointestinal perforation due to abdominal masses;

● Lower abdominal pain and difficulty in urinating and defecating due to a pelvic mass;

● When bone marrow metastasis occurs, there may be pallor, depression, weakness, loss of appetite, and easy bleeding from the nose or teeth;

● When central nervous system metastasis occurs, symptoms of cranial hypertension such as headache and vomiting or symptoms of spinal occupation such as cranial nerve paralysis or weakness of the lower extremities, diaphoresis or difficulty, or lethargy may be present;

When testicular metastasis occurs, it may be characterized by unilateral or bilateral enlargement of the testicle, hardening or nodularity, and lack of elasticity.

Clinical Department

1. General

In the diagnosis of Burkitt's lymphoma, routine tests include history taking and physical examination, laboratory tests, imaging, bone marrow examination, central nervous system examination, etc., pathologic histology and molecular biology, and the gold standard for diagnosis is pathology.

2. Consultation room

Hematology-Oncology, Hematology, Pediatrics, Hematology-Oncology Specialty, Pediatric Oncology

Examination & Diagnosis

1. Diagnostic basis

The gold standard for the diagnosis of Burkitt's lymphoma is a pathologic diagnosis.

2. Relevant inspections

1) Medical history and physical examination

In children with suspected Burkitt's lymphoma, care needs to be taken to take a history of current major symptoms, medical and past medical history, family history, growth and development, and vaccination history.

Physical examination should focus on superficial lymph nodes, liver, spleen and abdominal signs in addition to routine vital sign measurements.

2) Laboratory tests

Laboratory tests include routine blood tests, C-reactive protein (CRP), full biochemistry, coagulation pentameter, immune function, virological indexes (Hepatitis B virus, Hepatitis E virus, Syphilis spirochete, HIV, EBV, Cytomegalovirus, TORCH antibody), urine routine, stool routine and so on.

When bone marrow metastases are present, children may show signs of leukemia, such as increased/decreased white blood cells, decreased platelets, anemia, and elevated C-reactive protein.

In the presence of tumor lysis syndrome, serum lactate dehydrogenase (LDH) and uric acid are markedly elevated in children.

If the tumor invades the pancreas or compresses the common bile duct, it can lead to elevated pancreatic enzymes or elevated bilirubin.

At the onset or early stages of chemotherapy, children may develop coagulation abnormalities.

3) Imaging

Imaging tests include electrocardiogram, cardiac ultrasound, and enhanced CT of the chest, abdomen, and pelvis.PET-CT whole-body scanning may be used to assess the extent of tumor invasion as well as for efficacy assessment and review.

Sometimes doctors also use ultrasound to examine the tumor site, neck, abdomen, digestive tract, testicles or uterus, ovaries, pelvis, groin, armpits, and mediastinum.

4) Bone marrow examination

For children with suspected Burkitt's lymphoma, doctors usually take two sites of the sternum and ilium, or both ilium sites, or the tibia, and perform a bone marrow aspiration cytology smear and a bone marrow biopsy to confirm whether the tumor has invaded the bone marrow.

Flow cytometry was also used for immunophenotyping of myeloid lymphoma cells, and fluorescence in situ hybridization (FISH) was used for C-MYC gene detection of myeloid tumor cells.

5) Central Nervous System Examination

Enhanced magnetic resonance imaging (MRI) of the head and whole spinal cord, cerebrospinal fluid cytology, and cerebrospinal fluid flow cytometry lymphoma cell immunophenotyping may be used to confirm whether the tumor is invading the central nervous system.

6) Pathologic examination

Pathological examination is the gold standard for confirming the diagnosis of lymphoma, and the best case scenario is to excise the intact suspicious lymph nodes or excise part of the tumor tissue for pathohistological examination and use fluorescence in situ hybridization (FISH) for C-MYC gene detection of tumor cells.

5. Differential diagnosis

Burkitt's lymphoma requires a differential diagnosis from solid tumors of the abdominal cavity and face, as well as differentiation from other lymphomas, such as lymphoblastoid lymphoma.

Clinical Management

1. General

The treatment of Burkitt's lymphoma is based on the selection of different regimens and courses of treatment depending on the type of pathology and stage, with high-dose, short-course, pulsed therapy.

2. Chemotherapy

1) Chemotherapy regimen

For chemotherapy of childhood Burkitt's lymphoma, the more internationally agreed upon regimens are the modified LMB89 modified and BFM95 regimens.

The modified LMB89 regimen is intense and short, and its medications include vincristine, cyclophosphamide, prednisone, Zorubicin, methotrexate, cytarabine, and etoposide, and the specific regimen varies according to the risk grouping of groups A, B and C. Also, in patients in Groups B and C, rituximab (Merova) may be used in combination.

The BFM95 regimen also features the use of dexamethasone, methotrexate, etoposide, isocyclophosphamide, cytarabine, cyclophosphamide, and doxorubicin, with the exact regimen varying according to the BFM risk grouping, groups R1-R4. Also, in patients in groups R3 and R4, rituximab (Merova) can be used in combination.

It is important to note that each program should be directly and closely linked to avoid prolonged breaks in treatment.

CT every two sessions during chemotherapy to assess efficacy. PET/CT preferably 3 weeks after all chemotherapy is completed, residual lesions as possible

Surgical excision or biopsy is performed to clarify the diagnosis. Hematopoietic stem cell transplantation is recommended if there are active lesions.

2) Adverse Reactions

i) Acute tumor lysis syndrome

As Burkitt's lymphoma is sensitive to chemotherapy, during the initial treatment, if the tumor is high loaded, there will be a large number of tumor cells lysed and necrotic, causing tumor cytolysis syndrome, which manifests itself as symptoms such as hyperuricemia, hypophosphatemia, hypocalcemia, hypomagnesemia, and uric acid crystals blocking the renal tubules, which may lead to acute renal failure in severe cases, and it should be aggressively prevented and treated.

Often, doctors use medications or methods such as allopurinol, hydration, and uric acid oxidase to prevent acute tumor lysis syndrome. If acute tumor lysis syndrome occurs, it is treated aggressively for the appropriate symptoms.

ii) Cardiotoxicity

Anthracyclines can cause cardiotoxicity.

Anthracyclines may cause acute myocardial injury and chronic cardiac impairment. The former is transient and reversible localized myocardial ischemia, which may be manifested by panic, shortness of breath, chest tightness and precordial discomfort. The latter is irreversible congestive heart failure and is related to the cumulative dose of the drug. If cardiac function tests suggest abnormal cardiac function and are not due to infection, anthracyclines need to be suspended until cardiac function recovers. If myocardial injury occurs, drugs such as dexpropylenetramine (Zinecard) may be selected for treatment according to the condition.

iii) Hepatotoxicity

Some chemotherapeutic agents are toxic to the liver, as evidenced by elevated aminotransferases or bilirubin. Therefore, liver function tests are usually required before each course of treatment to determine whether chemotherapy can be given on time, and every 4-8 weeks during maintenance treatment, or every 12 weeks if there are no special circumstances.

Prior to high-dose methotrexate (MTX), a delay in dosing is required if transaminases are elevated 5-fold or more. In other courses, if the simple aminotransferase index (ALT/AST) is not elevated more than 10 times the high normal standard, then no adjustment of chemotherapy can be made; if ALT/AST reaches 10 times or more of the high normal limit, chemotherapy can be delayed, and if it is still abnormal after one week, chemotherapy can be given under close observation.

At present, there are some "liver-protecting drugs" on the market, but their role is not clear, the international major clinical programs do not routinely use "liver-protecting drugs", and there is no "liver-protecting drugs" to increase the safety of chemotherapy. There are no reports that "liver-protecting drugs" increase the safety of chemotherapy. In addition, hepatoprotective drugs may interact with chemotherapeutic drugs and increase the complexity of chemotherapeutic drug metabolism, so the use of prophylactic hepatoprotective drugs is not recommended.

iv) Neurotoxicity

The chemotherapeutic drugs cytarabine and vincristine are neurotoxic.

The dose of cytarabine in the treatment regimen needs to be adjusted when symptoms of cytarabine-associated neurotoxicity are so pronounced that they interfere with the normal life of the child.

Vincristine should not be used in a single maximum dose of more than 2 mg. Common mild neurotoxic side effects of Vincristine may be manifested as jaw pain, constipation, diminished deep reflexes, and sometimes vocal disturbances. If obvious signs of toxicity such as persistent abdominal colic, unsteady gait, severe pain, and abnormal secretion of the antidiuretic hormone urokinetic hormone (SIADH) are present, the dosage needs to be reduced or switched to the less neurotoxic vincristine. Antifungal drugs (azoles) can increase the neurotoxicity of neoplasms, and their concomitant use should be used with caution.

v) Acute Respiratory Distress Syndrome (ARDS)

Cytarabine is toxic to the lungs and may cause acute respiratory distress syndrome, which manifests as, for example, dyspnea, hypoxemia (SpO2 < 92%), and a chest line suggestive of infiltrates in both lungs. Children with such symptoms need to first rule out the possibility of pulmonary infection and cardiotoxicity of other chemotherapeutic agents by chest CT and cardiac ultrasound. If acute respiratory distress syndrome due to cytarabine is identified, it can be treated with glucocorticoids, with methylprednisolone recommended. A pediatric pulmonologist may be invited to consult if available.

vi) Nephrotoxicity

Nephrotoxic drugs (e.g., acyclovir) can cause subclinical renal abnormalities. Therefore, if a child is given these drugs at the same time as high-dose methotrexate, the administration of nephrotoxic drugs should be delayed until 20 hours after the high-dose methotrexate, if appropriate, or until the methotrexate has been adequately excreted.

vii) Hematological toxicity

Chemotherapeutic drugs remove tumor cells while also affecting normal hematopoiesis. Before chemotherapy with anthracyclines, the blood picture should meet the following standards: white blood cell count (WBC) ≥2.0×109 /L, absolute neutrophil count (ANC) ≥0.8×109 /L, platelet (PLT) ≥80×109 /L.

Granulocyte colony-stimulating factor (commonly known as leukapheresis) may be used if the child's neutropenia persists for 2-4 weeks without recovery or if it is anticipated that the child may have a prolonged period of neutrophil deficiency. Platelets should be transfused if the platelet count is less than 20 × 109 /L. The indications for transfusion may be relaxed if the child has significant bleeding symptoms or manifestations of infection. If anemia is present, it can usually be relieved by transfusion of red blood cells, and hematocrit below 60g/L must be transfused.

3. Other therapies

Autologous hematopoietic stem cell transplantation may also be considered for children with relapsed or refractory Burkitt's lymphoma.

4. Cutting-edge treatment

In the treatment of lymphoma, the application of anti-CD20 monoclonal antibody therapy is now becoming an important tool, with the drug rituximab (Merova).

Since Burkitt's lymphoma is a B-cell non-Hodgkin's lymphoma, the cellular immunotherapy CAR-T may also be effective.

In addition, bonatumumab, Bcl-2 inhibitors and BTK inhibitors can be used to treat Burkitt's lymphoma.

Prognosis

1. General

Currently, the five-year event-free survival rate for Burkitt's lymphoma is more than 80%, with the low-risk group approaching 100%.

Factors associated with poor prognosis include:

● The tumor invades the central nervous system;

● Staging as stage III or IV;

● Lactate dehydrogenase (LDH) >1000;

● There are two or three important disease-causing mutations;

● Tumor remission is shorter than 14 days per course of treatment and progresses rapidly;

● Drug insensitivity assessed early in treatment and tumor shrinkage <25% at 7 days of treatment;

● End of treatment assessment of residual lesions still active.

● Two courses of treatment more than 25 days apart.

2. Sequelae

Chemotherapy may increase the risk of secondary tumors, including the long-term risk, which is the risk of secondary tumors many years after treatment has ended. Therefore, children with Burkitt's lymphoma should be aware of the need for consistent review and follow-up after the end of treatment and for cancer screening after a certain age.

3. Recurrence/metastasis

Recurrence of Burkitt's lymphoma usually occurs within 2 years of stopping the drug; children who relapse have a poorer prognosis and should try different chemotherapy regimens and consider autologous hematopoietic stem cell transplantation, CAR-T, or targeted agents.

Follow-up & Review

1. General

Complete the treatment as prescribed by the doctor, maintain good living habits and a clean living environment, and take care to prevent infection. Regular follow-ups should be conducted after the completion of treatment in order to monitor recurrence and long-term adverse effects. Meanwhile, in daily life, children should be provided with nutritionally balanced diets, encouraged to have moderate activities, and attention should be paid to the psychological health of the children.

2. Review

Simple evaluation should be performed every 3 months for the first 2 years after discontinuation of the drug, with ultrasound or CT scanning and testing of liver function and LDH; major evaluation should be performed every 6 months, with ultrasound, enhanced CT or nuclear magnetic scanning of the tumor lesion, testing of immune function, liver function, LDH, and repeat bone puncture if there is bone marrow invasion.

Evaluation every 6 months from the third year of drug discontinuation, ultrasound or CT scanning of tumor foci, testing of liver function and LDH, and additional tests of endocrine hormones and intelligence, as appropriate.

Routine

1. Home care

Since children under treatment often have reduced immunity, care should be taken to prevent infection. Pay attention to washing hands frequently, keeping food and drinking water clean and hygienic, and good living hygiene habits. Keep the living environment neat and clean, open windows regularly to maintain air circulation. Do not put fresh flowers and potted flowers indoors for the time being. Garbage cans should be covered and garbage should not be stored for more than 2 hours. At the same time, the contact between the child and the infected patient should be reduced, and the infection of the accompanying staff should also be noted. If someone in the family has a cold, contact with the child should be avoided as much as possible; if contact with the child is necessary, hand washing (with soap or hand sanitizer), wearing a mask and other protective measures must be done. At the same time, parents should pay attention to daily observation of the child's condition and seek medical attention as soon as possible if there are signs of infection or fever.

2. Daily life management

1) Diet

Both during and after treatment, it is recommended to provide children with a nutritious and balanced diet, guaranteeing the intake of high-quality proteins (e.g., meat, eggs, milk, poultry, fish and shrimp, soybeans and soybean products, quinoa, etc.), as well as more grains and cereals and fruits and vegetables, and dairy products and nuts in moderation, in order to ensure the intake of other nutrients. At the same time should eat less refined rice and white flour, deep-processed snacks and processed meat tumors, control oil and salt.

In addition, during the treatment period, the child's immunity will be reduced and expired, spoiled, unclean and potentially food-safe foods should be avoided. Specific dietary advice can be obtained from the dietitian at your hospital.

2) Movement

If the physical condition of the child allows, you can encourage and assist the child to do some activities. Moderate exercise is helpful in preventing muscle atrophy, increasing physical strength and endurance, and promoting appetite.

Appropriate regular exercise is recommended after the child has finished treatment. If available, consider 30-60 minutes of moderate-intensity exercise per day (e.g., brisk walking, bicycling, yoga, table tennis, etc.) or a moderate amount of high-intensity exercise per week (e.g., running, swimming, jumping rope, aerobics, basketball, etc.).

3) Lifestyle

Studies have shown that children with tumors are at a higher risk of long-term cardiovascular disease, metabolic disease, and secondary cancers than the general population. A healthy lifestyle, such as a balanced diet and moderate exercise, is the most important and effective means of preventing these diseases. Children are also advised to pay attention to weight control, as being overweight may increase the risk of developing cancer (e.g., breast, pancreatic, rectal, endometrial, etc.) later in life.

In addition, regular and quality sleep is helpful for immunity and physical recovery, so patients need sufficient sleep time and good sleep quality. Providing a good sleeping environment will be helpful to improve the quality of sleep of patients, such as keeping the environment quiet, no noise, dim light and suitable temperature.

4) Emotional psychology

The treatment process for Burkitt's lymphoma can be very challenging for the child and requires attention to the child's mental health. Physical changes and pain caused by the disease and treatment, isolation and lack of external peer contact during treatment, falling behind in school, and fear of not being accepted by peers can all affect a child's mental health. Parents need to guide their children to face the disease with a positive attitude, accept their physical changes, and encourage them to maintain external contacts, play with classmates and friends, and return to school and reintegrate into the society as early as possible under the premise of ensuring hygiene during the treatment process. If the child has a psychological disorder, a psychologist can be called in to intervene.

5. Daily condition monitoring

In the course of treatment, it is necessary to observe the side effects caused by the treatment, as well as the complications and the regression of the patient's condition, and consult the doctor in time when side effects and complications appear. After the completion of treatment, it is necessary to observe the delayed complications, the growth and development of the child, the recurrence of the disease, and adhere to regular follow-up. When new symptoms or complications appear, consult your doctor.

3. Special Considerations

1) Precautions to be taken when platelets are too low

If the child's platelets are too low (usually less than 20x109/L), care needs to be taken to avoid bleeding by staying away from sharp, prickly toys and objects, and avoiding all impact sports (such as bouncing, soccer, basketball, etc.). When eating, be careful to avoid bones and other foods that tend to poke the mouth, and use a soft-bristled brush when brushing teeth. At the same time, for younger children, should try to avoid violent crying to avoid intracranial hemorrhage. In addition, take care to keep the child's bowels clear, and do not self-administer anal suppositories or measure anal temperature to avoid rectal bleeding. Do not give your child medications that tend to cause bleeding, such as aspirin or ibuprofen, unless your doctor recommends it. Some over-the-counter cold medicines may have ingredients such as ibuprofen that require special attention.

2) Keeping case records

Patients with Burkitt's lymphoma are at risk for long-term side effects and secondary tumors, the onset of which may occur many years after the end of treatment for Burkitt's lymphoma, and this risk is related to the regimen and dosage used in the treatment of Burkitt's lymphoma. Therefore, it is important to keep records of all of your child's medical visits and treatments for future reviews and medical appointments.

7. Prevention

There is no known method of prevention for Burkitt's lymphoma. However, certain environmental or genetic factors such as EBV infection and congenital or acquired immunodeficiency syndrome are known to be associated with an increased risk of Burkitt's lymphoma (see "Predisposing Factors"). Therefore, parents can take care to avoid relevant environmental factors. If there are genetic factors such as congenital immunodeficiency syndrome, parents can pay attention to the early symptoms of Burkitt's lymphoma and seek early medical treatment once detected, so as to achieve early detection and early treatment and strive for the best therapeutic effect.

Cutting-edge Therapeutic & Clinical Research

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References

1. Chinese Society of Clinical Oncology Guidelines Working Committee. Chinese Society of Clinical Oncology (CSCO) Guidelines for the Diagnosis and Treatment of Childhood and Adolescent Lymphoma 2020. Burkitt's Lymphoma. Burkitt's Lymphoma. 2020.

2. Chinese People's Republic and Health Care Commission. Diagnostic and therapeutic norms for mature B-cell lymphoma in children (2019 edition). 2019.

3.TermuhlenAM, GrossTG. Overview of non-Hodgkin lymphoma in children and adolescents.In: UpToDate, Park, JR, Rosmarin, AG (Ed), UpToDate, Waltham, MA, 2020.

4.PDQ® Pediatric Treatment Editorial Board. PDQ Childhood Non-Hodgkin Lymphoma Treatment. Bethesda, MD: National Cancer Institute. updated <08/ 07/2020>. Available at.

https://www.cancer.gov/types/lymphoma/hp/child-nhl-treatment-pdq

Accessed <08/14/2020>. [PMID: 26389181]

5. https://rarediseases.info.nih.gov/diseases/5973/burkitt-lymphoma