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Xie Y, Jia M, Shi J, Tao Y. Inferior prognosis of gastric involvement in patients with gastrointestinal Burkitt Lymphoma. Cancer Med 2020; 9:3107-3114. [PMID: 32160410 PMCID: PMC7196052 DOI: 10.1002/cam4.2975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 01/30/2020] [Accepted: 02/22/2020] [Indexed: 12/15/2022] Open
Abstract
Due to limited information reported on the clinical characteristics and outcomes of Burkitt lymphoma (BL) patients with gastrointestinal (GI) involvement, here we used the Surveillance, Epidemiology, and End Results (SEER) database to perform our study in a population‐based scale. Extranodal GI involvement was categorized into gastric and intestinal primary sites. A total of 477 BL patients with GI involvement extracted from the SEER database between 2004 and 2015 were included in this study, 112 (23.5%) with the stomach and 365 (76.5%) with the intestine. Our study demonstrated that gastric involvement, older age, male gender, black race, advanced‐stage III/IV, no‐chemotherapy, and earlier years of diagnosis were associated with a significantly worse overall survival (OS) in GI BL patients after adjustment in multivariate analysis, whereas marital status did not significantly influence OS. Notably, BL Patients with gastric involvement had a significantly inferior 5‐year OS in both univariate and multivariate analysis, as compared to those with intestinal involvement (37.8% vs. 70.2%; Univariate: HR = 2.637, P < .001; Multivariate: HR = 1.489, P = .016). In subgroup analysis, we demonstrated that gastric BL patients had a consistently worse OS than intestinal patients regardless of gender, clinical stage and year of diagnosis. Hopefully, with the advances in modern therapy, improved survival has been found in BL patients with GI involvement as a whole, specifically those with gastric involvement (HR = 0.529, P = .011) in recent years of diagnosis. In conclusion, despite the improved survival achieved in recent years, the prognosis of BL patients with gastric involvement is still poor. Novel personalized therapies and better access to intensive care remain to be needed.
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Affiliation(s)
- Yi Xie
- Department of Hematology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Mengyu Jia
- Department of Hematology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jumei Shi
- Department of Hematology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yi Tao
- Department of Hematology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
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2
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Ayoub F, Forde JJ, Patel N, Markham M. Primary gastric Burkitt lymphoma: a rare cause of life-threatening haematemesis. BMJ Case Rep 2017; 2017:bcr-2017-220313. [PMID: 28830898 DOI: 10.1136/bcr-2017-220313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Lymphomas are the second most common gastric malignancy following gastric adenocarcinoma. The majority of gastric lymphomas are either mucosa-associated lymphoid tissue lymphomas or diffuse large B-cell lymphomas. Primary gastric Burkitt lymphoma is a subtype of non-Hodgkin's lymphoma and represents an aggressive and rare malignancy with only a small number of cases reported worldwide. Clinical and radiological presentation is non-specific and mimics other gastric lymphomas. Diagnosis is established with pathological evaluation. Due to the paucity of cases, treatment of this condition is not well studied and is extrapolated from paediatric and adult literature of Burkitt lymphoma not isolated to the stomach. We present the case of a male patient with primary gastric Burkitt lymphoma who initially presented with life-threatening haematemesis, later achieving complete remission with treatment. We discuss the epidemiology, presentation and management of gastric Burkitt lymphoma.
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Affiliation(s)
- Fares Ayoub
- Department of Medicine, University of Florida, Gainesville, Florida, USA
| | - Justin J Forde
- Department of Medicine, University of Florida, Gainesville, Florida, USA
| | - Niraj Patel
- Department of Medicine, University of Florida, Gainesville, Florida, USA
| | - Merry Markham
- Division of Hematology and Oncology, Department of Medicine, University of Florida, Gainesville, Florida, USA
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3
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Rwegerera GM, Rivera YP, Zhou F, Chobanga KJ, Sesay SO. Disseminated Burkitt's Lymphoma with a Pancreatic Mass in a HIV Positive Woman Diagnosed by Axillary Lymph Node Biopsy. J Clin Diagn Res 2017; 11:OD14-OD16. [PMID: 28969187 PMCID: PMC5620828 DOI: 10.7860/jcdr/2017/27456.10493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 06/07/2017] [Indexed: 11/24/2022]
Abstract
Burkitt's Lymphoma (BL) is a highly aggressive B cell lymphoma of non-Hodgkin's type usually presenting in extranodal sites for endemic and sporadic types of the disease. Like other non-Hodgkin's Lymphomas (NHL), HIV positive associated BL is associated with peripheral lymphadenopathy. We present a case of 22-year-old newly diagnosed HIV positive female patient who presented with generalized peripheral lymphadenopathy and obstructive jaundice. Initial work up was suggestive of acute pancreatitis with further evaluation revealing a pancreatic head mass. BL was confirmed both by axillary lymph node biopsy and immunohistochemistry, highlighting the importance of high index of suspicion and prompt histopathological diagnosis to enable treatment of this fatal disease that is potentially curable.
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Affiliation(s)
- Godfrey Mutashambara Rwegerera
- Senior Lecturer, Department of Internal Medicine, Faculty of Medicine, University of Botswana and Princess Marina Hospital, Gaborone, Botswana
| | - Yordanka Pina Rivera
- Lecturer, Department of Internal Medicine, Faculty of Medicine, University of Botswana and Princess Marina Hospital, Gaborone, Botswana
| | - Feng Zhou
- Pathologist, Department of Histopathology, National Health Laboratory Gaborone, Botswana
| | - Kudra Jumanne Chobanga
- Lecturer, Department of Obstetrics and Gynecology, Faculty of Medicine, University of Botswana and Princess Marina Hospital, Gaborone, Botswana
| | - Sheikh Omar Sesay
- Consultant, Department of Radiology, Princess Marina Hospital, Gaborone, Botswana
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Harris AC, MacLean KA, Grunau GL, Chang SD, Martin N. Imaging Intra-abdominal Burkitt's Lymphoma: From Discrete Bowel Wall Thickening to Diffuse Soft Tissue Infiltration. Can Assoc Radiol J 2017; 68:286-292. [PMID: 28578810 DOI: 10.1016/j.carj.2016.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 08/12/2016] [Accepted: 08/15/2016] [Indexed: 11/18/2022] Open
Abstract
Burkitt's lymphoma is a highly aggressive non-Hodgkin's B-cell lymphoma, which often presents with intra-abdominal involvement. The purpose of this pictorial review is to illustrate the various intra-abdominal imaging findings of Burkitt's lymphoma. Extranodal disease at presentation is common, including involvement of the bowel, stomach, pancreas, spleen, and mesentery.
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Affiliation(s)
- Alison C Harris
- Department of Radiology, Abdominal Division, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kelly A MacLean
- University of British Columbia Radiology Residency Program, Vancouver, British Columbia, Canada
| | - Gilat L Grunau
- University of British Columbia Radiology Residency Program, Vancouver, British Columbia, Canada.
| | - Silvia D Chang
- Department of Radiology, Abdominal Division, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nancy Martin
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
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Mitra S, Mehta A, Gupta SK, Sharma A, Louis AR, Sharma MK, Saxena U, Simson DK, Dewan A. Primary Gastric Burkitt's Lymphoma. Rare Tumors 2014; 6:5300. [PMID: 25568743 PMCID: PMC4274437 DOI: 10.4081/rt.2014.5300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 07/14/2014] [Accepted: 08/04/2014] [Indexed: 02/07/2023] Open
Abstract
The primary gastrointestinal non-Hodgkin’s lymphoma, although rare, is among the most common extra-nodal lymphomas, considering that gastric lymphomas are more common than intestinal lymphomas. Burkitt’s lymphoma (BL) is an aggressive form of B-cell lymphoma that is typically endemic in Africa, while non-endemic cases are found in the rest of the world. Primary gastric BL is extremely rare and only around 50 cases have been reported worldwide. Here we present the case of a young HIV-negative male, who was referred to our department with a stage IV gastric BL. He was planned for palliative chemotherapy, but after the first cycle of chemotherapy he succumbed to the progression of the disease.
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Affiliation(s)
| | | | - Sunil Kumar Gupta
- Departments of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Center , New Delhi, India
| | | | - A Robert Louis
- Departments of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Center , New Delhi, India
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Jang G, Yoon DH, Kim S, Lee DH, Lee SW, Huh J, Suh C. Addition of rituximab to the CHOP regimen has no benefit in patients with primary extranodal diffuse large B-cell lymphoma. THE KOREAN JOURNAL OF HEMATOLOGY 2011; 46:103-10. [PMID: 21747882 PMCID: PMC3128890 DOI: 10.5045/kjh.2011.46.2.103] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2011] [Revised: 06/07/2011] [Accepted: 06/08/2011] [Indexed: 11/17/2022]
Abstract
BACKGROUND The addition of rituximab to cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) chemotherapy (R-CHOP) has significantly improved clinical outcomes for patients with diffuse large B-cell lymphoma (DLBCL). However, new predictors of patient response to R-CHOP have not been established. We aimed to evaluate the impact of R-CHOP compared with CHOP in patients with DLBCL and to establish clinical predictors of better outcomes in these patients. METHODS We retrospectively identified 177 patients diagnosed with CD20-positive DLBCL and treated with CHOP (N=82) or R-CHOP (N=95). The response rate, event-free survival (EFS), and overall survival (OS) rates were compared between the 2 treatment groups. All patients were classified into primary extranodal lymphoma (PENL) or nodal lymphoma (NL) subgroups, and the clinical parameters of each subgroup were analyzed. RESULTS The overall response rate was higher in R-CHOP group (95% vs. 84%, P=0.07). The 3-year EFS rate was significantly higher in R-CHOP group (71% vs. 52%, P=0.013), but the OS rate was comparable between the 2 groups (79% vs. 69%, P=0.23). A significant survival benefit was seen with R-CHOP compared to CHOP therapy in NL patients (P=0.002 for EFS and 0.04 for OS). Multivariate analyses confirmed that R-CHOP therapy is an independent prognostic factor for EFS (hazard ratio of 0.32 [0.17-0.62], P=0.001) and OS (hazard ratio of 0.4 [0.18-0.87], P=0.02) in NL patients. CONCLUSION Patients in the PENL group did not benefit from R-CHOP chemotherapy.
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Affiliation(s)
- Geundoo Jang
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Yoo C, Kim S, Sohn BS, Kim JE, Yoon DH, Huh J, Lee DH, Kim SW, Lee JS, Suh C. Modified number of extranodal involved sites as a prognosticator in R-CHOP-treated patients with disseminated diffuse large B-cell lymphoma. Korean J Intern Med 2010; 25:301-8. [PMID: 20830228 PMCID: PMC2932944 DOI: 10.3904/kjim.2010.25.3.301] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2009] [Revised: 01/21/2010] [Accepted: 04/05/2010] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS Rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone chemotherapy (R-CHOP) has improved survival in patients with diffuse large B-cell lymphoma (DLBCL) and weakened the prognostic power of the international prognostic index (IPI). We evaluated the efficacy of the IPI and revised IPI (R-IPI) in patients with DLBCL who were treated with R-CHOP, focusing on extranodal site number (ENS) because extranodal involvement occurs frequently in Koreans. METHODS A total of 126 R-CHOP-treated patients with stage III/IV DLBCL were analyzed. We performed a retrospective analysis of the clinicopathologic factors and verified the predictive power of the standard IPI and R-IPI. Various numbers of extranodal sites were analyzed for further stratification, and we set the extranodal site-modified IPI (E-IPI) as the IPI when the number of extranodal sites was stratified as < 3 vs. ≥ 3. RESULTS A univariate analysis showed that ENS was associated with complete response (CR, p = 0.04), event-free survival (EFS, p = 0.01), and overall survival (OS, p < 0.001) when the ENS cut-off was set at ≥ 3. A multivariate analysis revealed that an ENS ≥ 3 remained associated with EFS (p < 0.01; hazard ratio [HR], 2.60; 95% confidence interval [CI], 1.29 to 5.26) and OS (p < 0.01; HR, 3.52; 95% CI, 1.68 to 7.35). The IPI was effective for determining prognosis in terms of OS (p = 0.04) but not EFS (p = 0.17). The R-IPI was effective in terms of both variables (p = 0.02 and 0.04, respectively), as was the E-IPI (p = 0.01 and 0.001, respectively). CONCLUSIONS An ENS < 3 vs. ≥ 3, rather than the original < 2 vs. ≥ 2, was the most significant prognostic factor for EFS and OS. All three indices were predictive, but only the E-IPI identified the high-risk group of R-CHOP-treated Korean patients with disseminated DLBCL.
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Affiliation(s)
- Changhoon Yoo
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Shin Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byeong Seok Sohn
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong-Eun Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dok Hyun Yoon
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jooryung Huh
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dae Ho Lee
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang-We Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung-Shin Lee
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Cheolwon Suh
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Baumgaertner I, Copie-Bergman C, Levy M, Haioun C, Charachon A, Baia M, Sobhani I, Delchier JC. Complete remission of gastric Burkitt’s lymphoma after eradication of Helicobacter pylori. World J Gastroenterol 2009; 15:5746-50. [PMID: 19960575 PMCID: PMC2789231 DOI: 10.3748/wjg.15.5746] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Burkitt’s lymphoma is a highly aggressive non-Hodgkin lymphoma, often presenting in extra-nodal sites. It generally has a poor spontaneous outcome and needs aggressive treatment with systemic and intrathecal chemotherapy. Occurrence at the gastric site is rare. We report the case of a 39-year old woman who presented with a prominent ulcerated lesion of the antrum corresponding histologically to a Burkitt’s lymphoma associated with Helicobacter pylori (H pylori) infection. Interphase fluorescence in situ hybridization (FISH) demonstrated c-MYC gene rearrangement in tumour cells without BCL2 or BCL6 gene translocations. Ulcer healing and tumour regression with a complete histological response were obtained 8 wk after H pylori eradication. In spite of this complete remission, taking into account the high risk of recurrence, the patient received systemic and intrathecal chemotherapy. Two years later, the patient remained in complete remission. This is the first report of a gastric Burkitt’s lymphoma responding to H pylori eradication. These findings raise the question of the potential role of H pylori in the pathogenesis of some gastric Burkitt’s lymphomas, and show the importance of searching for and eradicating the bacteria in combination with conventional chemotherapy regimens.
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Faltas B, Kramer ZB. Gastric Burkitt lymphoma associated with Efalizumab and Helicobacter pylori. Leuk Lymphoma 2009; 50:1538-9. [PMID: 19603348 DOI: 10.1080/10428190903085969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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10
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The effect of adding rituximab to CHOP-based therapy on clinical outcomes for Japanese patients with diffuse large B-cell lymphoma: a propensity score matching analysis. Int J Hematol 2009; 89:326-331. [DOI: 10.1007/s12185-009-0259-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2008] [Revised: 01/06/2009] [Accepted: 01/27/2009] [Indexed: 10/21/2022]
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Treatment outcome of adult patients with Burkitt lymphoma: results using the LMB protocol in Korea. Ann Hematol 2009; 88:1099-106. [DOI: 10.1007/s00277-009-0729-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2008] [Accepted: 03/04/2009] [Indexed: 11/25/2022]
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Abstract
Lymphomas are the third most common cancer in children and Burkitt lymphoma (BL) accounts for about 40% of them. The rectum is extremely seldom involved in BL: 91 children were treated at our institution for BL between 1987 and June 2006, but none of them had involved the rectum. We report here on a 9-year-old boy who presented with bowel bleeding and subocclusion, which proved due to a BL of the rectum. The role of surgery for this tumor is limited nowadays, except for surgical emergencies, biopsies, and second-look surgery in selected cases.
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Current Awareness in Hematological Oncology. Hematol Oncol 2006. [DOI: 10.1002/hon.755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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