Gender and age-related differences in Burkitt lymphoma--epidemiological and clinical data from The Netherlands

Presentation of B-cell lymphoma in childhood and adolescence: a systematic review and meta-analysis

BACKGROUND

The diagnosis of B-cell lymphoma, one of the commonest cancers seen in childhood and adolescence, is challenging. There is a crucial need to identify and delineate the prevalence of associated symptoms in order to improve early diagnosis.

AIMS

To identify clinical presentations associated with childhood and adolescent B-cell lymphomas and estimate symptom prevalence.

METHODS

A systematic review of observational studies and meta-analysis of proportions was carried out. Medline and EMBASE were systematically searched, with no language restrictions, from inception to 1st August 2022. Observational studies with at least 10 participants, exploring clinical presentations of any childhood and adolescent lymphoma, were selected. Proportions from each study were inputted to determine the weighted average (pooled) proportion, through random-effects meta-analysis.

RESULTS

Studies reported on symptoms, signs and presentation sites at diagnosis of 12,207 children and adolescents up to the age of 20. Hodgkin's lymphoma most frequently presented with adenopathy in the head-and-neck region (79% [95% CI 58%-91%]), whilst non-Hodgkin's lymphoma presented abdominally (55% [95% CI 43%-68%]). Symptoms associated with lymphoma included cervical lymphadenopathy (48% [95% CI 20%-77%]), peripheral lymphadenopathy (51% [95% CI 37%-66%]), B-symptoms (40% [95% CI 34%-44%]), fever (43% [95% CI 34%-54%]), abdominal mass (46% [95% CI 29%-64%]), weight loss (53% [95% CI 39%-66%]), head-and-neck mass (21% [95% CI 6%-47%]), organomegaly (29% [95% CI 23%-37%]), night sweats (19% [95% CI 10%-32%]), abdominal pain (28% [95% CI 15%-47%]), bone pain (17% [95% CI 10%-28%]) and abnormal neurology (11% [95% CI 3%-28%]).

CONCLUSION

This systematic review and meta-analysis of proportions provides insight into the heterogeneous clinical presentations of B-cell lymphoma in childhood and adolescence and provides estimates of symptom prevalence. This information is likely to increase public and clinical awareness of lymphoma presentations and aid earlier diagnosis. This review further highlights the lack of studies exploring childhood and adolescent lymphoma presentations in primary care, where patients are likely to present at the earliest stages of their disease.

First reported case: Uncommon presentation of Burkitt lymphoma as perineal ulceration in a young patient

INTRODUCTION AND IMPORTANCE

Burkitt lymphoma (BL) is an aggressive subtype of non-Hodgkin lymphoma with a predilection for pediatric patients, known for its rapid growth and MYC oncogene-associated chromosomal translocations.

CASE PRESENTATION

A 33-year-old male presented with a perineal ulcerated wound, initially misdiagnosed as a musculoskeletal injury. Imaging and histopathological analysis eventually confirmed BL, leading to the initiation of high-dose chemotherapy.

CLINICAL DISCUSSION

BL is characterized by its rapid growth, typically as masses in the abdomen or jaw. Nevertheless, atypical presentations can lead to diagnostic delays, underscoring the importance of considering BL even in the absence of classic symptoms. Swift recognition and accurate diagnosis are critical for initiating timely chemotherapy. Comprehensive clinical evaluation, advanced imaging, and histopathological analysis are pivotal in confirming the diagnosis.

CONCLUSION

This unique case of BL with a perineal mass presentation emphasizes the necessity of considering BL as a potential diagnosis in atypical cases, highlighting the importance of early recognition and appropriate therapeutic strategies. Healthcare professionals should be aware of the potential for unusual BL presentations.

The RNA helicase DDX3 and its role in c-MYC driven germinal center-derived B-cell lymphoma

DDX3X is an RNA helicase with many functions in RNA metabolism such as mRNA translation, alternative pre-mRNA splicing and mRNA stability, but also plays a role as a regulator of transcription as well as in the Wnt/beta-catenin- and Nf-κB signaling pathways. The gene encoding DDX3X is located on the X-chromosome, but escapes X-inactivation. Hence females have two active copies and males only one. However, the Y chromosome contains the gene for the male DDX3 homologue, called DDX3Y, which has a very high sequence similarity and functional redundancy with DDX3X, but shows a more restricted protein expression pattern than DDX3X. High throughput sequencing of germinal center (GC)-derived B-cell malignancies such as Burkitt Lymphoma (BL) and Diffuse large B-cell lymphoma (DLBCL) samples showed a high frequency of loss-of-function (LOF) mutations in the DDX3X gene revealing several features that distinguish this gene from others. First, DDX3X mutations occur with high frequency particularly in those GC-derived B-cell lymphomas that also show translocations of the c-MYC proto-oncogene, which occurs in almost all BL and a subset of DLBCL. Second, DDX3X LOF mutations occur almost exclusively in males and is very rarely found in females. Third, mutations in the male homologue DDX3Y have never been found in any type of malignancy. Studies with human primary GC B cells from male donors showed that a loss of DDX3X function helps the initial process of B-cell lymphomagenesis by buffering the proteotoxic stress induced by c-MYC activation. However, full lymphomagenesis requires DDX3 activity since an upregulation of DDX3Y expression is invariably found in GC derived B-cell lymphoma with DDX3X LOF mutation. Other studies with male transgenic mice that lack Ddx3x, but constitutively express activated c-Myc transgenes in B cells and are therefore prone to develop B-cell malignancies, also showed upregulation of the DDX3Y protein expression during the process of lymphomagenesis. Since DDX3Y is not expressed in normal human cells, these data suggest that DDX3Y may represent a new cancer cell specific target to develop adjuvant therapies for male patients with BL and DLBCL and LOF mutations in the DDX3X gene.

Comparison of chemotherapy regimens plus rituximab in adult Burkitt lymphoma: A single-arm meta-analysis

Background and aim

Given the paucity of evidence-based treatment recommendations, the most appropriate first-line regimen for adult Burkitt lymphoma is currently undefined. We aimed to identify the optimal treatment regimen containing rituximab for adult Burkitt lymphoma patients.

Methods

The PubMed, Embase, Web of Science, and Cochrane databases were searched in December 2021 (10). We included all studies for the treatment of Burkitt lymphoma including rituximab. We excluded studies of patients aged ≤14 years old and those with sample numbers ≤10 patients. Random-effects models were used to compare different chemotherapy regimens regarding estimated 2-year overall survival (OS) rate, 2-year progression-free survival (PFS) rate, and overall response rate (ORR).

Results

A total of 17 studies were included in this meta-analysis and divided into four groups: CODOX-M/IVAC, DA-EPOCH, GMALL-B-ALL/NHL2002, and Hyper-CVAD. DA-EPOCH was associated with a significantly higher 2-year OS rate [0.95, 95% confidence interval (CI) 0.86-1.00]. There was no significant difference in the 2-year PFS rates (0.81, 95% CI 0.76-0.85) and ORR (0.90, 95% CI 0.87-0.94) between these four treatment regimens.

Conclusions

The meta-analysis indicates that DA-EPOCH could be more effective in providing curative treatment for adult Burkitt lymphoma patients, especially without CNS and BM involvement considering OS time. Due to the types of studies and the limited number of included studies, bias should be acknowledged and a randomized controlled trial (RCT) needs to be performed to further identify the optimal treatment regimen for such patients.

The Primary Outbreaks of Burkitt Lymphoma in the Oral Cavity. A Report of Two Cases, Review of the Literature and Dental Implications

Two cases of Sporadic Burkitt’s lymphoma in children aged 11 and 8 years with primary symptoms in the oral cavity are reported. The first symptoms of the disease appeared in the oral cavity and were initially misdiagnosed as an inflammatory condition in one case and incidental findings not associated with the primary reason for visiting the dentist’s office in the second case. Biopsies of the lesions revealed the actual cause of the observed changes and contributed to the prompt initiation of polychemotherapy treatment. A review of current literature presents the known symptoms of Burkitt’s Lymphoma in the oral cavity and the available diagnostic methods. The role of the primary care physicians—the pedodontist and paediatrician—in the diagnostic and therapeutic process is discussed.

Survival Predictors of Head and Neck Burkitt's Lymphoma: An Analysis of the SEER Database

OBJECTIVE

To analyze population-level data for Burkitt's lymphoma of the head and neck.

STUDY DESIGN

Retrospective study of a national cancer database.

SETTING

Academic medical center.

METHODS

The SEER database (Surveillance, Epidemiology, and End Results) identified all patients with primary Burkitt's lymphoma of the head and neck from 1975 to 2015. Demographic, clinicopathologic, and treatment characteristics were analyzed. Multivariable Cox regressions analyzed factors associated with survival while controlling for baseline differences.

RESULTS

A total of 920 patients with a mean (SD) age of 37.6 years (25.0) were identified. A majority of patients were White (82.8%) and male (72.3%). The most primary common sites included the lymph nodes (61.3%), pharynx (17.7%), and nasal cavity/paranasal sinuses (5.2%). The majority of patients received chemotherapy (90.5%), while fewer underwent surgery (42.1%) or radiotherapy (12.8%). Choice of treatment differed significantly among patients of different ages, year of diagnosis, primary site, nodal status, and Ann Arbor stage. Overall 10-year survival was 67.8%. On multivariable Cox regression, patients with older age (hazard ratio [HR], 1.05 per year; P < .001) and higher stage at presentation had increased risk of mortality (P < .001). Furthermore, cases diagnosed between 2006 and 2015 (HR, 0.35; P < .001) and 1996 and 2005 (HR, 0.53; P = .001) had lower mortality when compared with those diagnosed between 1975 and 1995. Treatment including surgery and chemotherapy tended to have the best survival (P < .001).

CONCLUSION

Burkitt's lymphoma of the head and neck diagnosed in more recent years has had improved survival. Factors significantly associated with survival include age, Ann Arbor stage, and treatment regimen. Treatment including surgery and chemotherapy was associated with the highest survival.

Proteomic approaches to investigate gammaherpesvirus biology and associated tumorigenesis

The DNA viruses, Kaposi's sarcoma-associated herpesvirus (KSHV) and Epstein-Barr virus (EBV), are members of the gammaherpesvirus subfamily, a group of viruses whose infection is associated with multiple malignancies, including cancer. The primary host for these viruses is humans and, like all herpesviruses, infection with these pathogens is lifelong. Due to the persistence of gammaherpesvirus infection and the potential for cancer formation in infected individuals, there is a driving need to understand not only the biology of these viruses and how they remain undetected in host cells but also the mechanism(s) by which tumorigenesis occurs. One of the methods that has provided much insight into these processes is proteomics. Proteomics is the study of all the proteins that are encoded by a genome and allows for (i) identification of existing and novel proteins derived from a given genome, (ii) interrogation of protein-protein interactions within a system, and (iii) discovery of druggable targets for the treatment of malignancies. In this chapter, we explore how proteomics has contributed to our current understanding of gammaherpesvirus biology and their oncogenic processes, as well as the clinical applications of proteomics for the detection and treatment of gammaherpesvirus-associated cancers.

Global and regional incidence, mortality and disability-adjusted life-years for Epstein-Barr virus-attributable malignancies, 1990-2017

OBJECTIVE

To determine the global and regional burden of Epstein-Barr virus (EBV)-attributed malignancies.

DESIGN

An international comparative study based on the Global Burden of Disease (GBD) Study estimates.

SETTING

Global population by age, sex, region, demographic index and time.

METHODS AND OUTCOME MEASURES

The burden of EBV-attributed Burkitt lymphoma (BL), Hodgkin lymphoma (HL), nasopharyngeal carcinoma (NPC) and gastric carcinoma (GC) was estimated in a two-step process. In the first step, the fraction of each malignancy attributable to EBV was estimated based on published studies; this was then applied to the GBD estimates to determine the global and regional incidence, mortality and disability-adjusted life-years (DALYs) for each malignancy by age, sex, geographical region and social demographic index (SDI) from 1990 to 2017.

RESULTS

The combined global incidence of BL, HL, NPC and GC in 2017 was 1.442 million cases, with over 973 000 deaths. An estimated 265 000 (18%) incident cases and 164 000 (17%) deaths were due to the EBV-attributed fraction. This is an increase of 36% in incidence and 19% in mortality from 1990. In 2017, EBV-attributed malignancies caused 4.604 million DALYs, of which 82% was due to NPC and GC alone. The incidence of both of these malignancies was higher in high and middle-high SDI regions and peaked in adults aged between 50 and 70 years. All four malignancies were more common in males and the highest burden was observed in East Asia.

CONCLUSIONS

This study provides comprehensive estimates of the burden of EBV-attributed BL, HL, NPC and GC. The overall burden of EBV-related malignancies is likely to be higher since EBV is aetiologically linked to several other malignancies not included in this analysis. Increasing global population and life expectancy is expected to further raise this burden in the future. The urgency for developing an effective vaccine to prevent these malignancies cannot be overstated.

Clinicopathological analysis of oral Burkitt's lymphoma in pediatric patients: A systematic review

The aim of this study was to integrate the available data regarding pediatric Burkitt's lymphoma (BL) of the oral cavity. A systematic review was conducted following PRISMA guidelines, through a specific search strategy. Twenty-nine publications were included in this study, resulting in a total of 144 cases. Oral BL was predominantly found in males (75.7%). The mandible was the most involved site (37.5%), and all cases clinically exhibited a swelling. Presence of EBV was observed in 33.3% of the cases, and 4 cases reported HIV-positive patients (33.3%). Chemotherapy was the leading treatment choice for oral BL (94.9%), and the overall 5-year survival was 54.3%. Regarding the quality assessment of the studies, most (19 studies; 65.5%) were classified as an overall moderate risk of bias. In conclusion, the clinicopathological characteristics of oral BL in the pediatric population comprise the sporadic and intermediate subtypes. Despite its aggressiveness, this malignancy presents a moderate overall survival.

Seroprevalence of Epstein-Barr virus among children and adults in Tehran, Iran

Epstein–Barr virus (EBV) as a herpes virus can be associated with numerous infections and cancers. The virus is known to cause infectious mononucleosis. There is no accurate estimation of the seroprevalence of EBV in Tehran, so this study aimed to estimate the seroprevalence of EBV among children and adults in Tehran, Iran. This descriptive–analytical study was conducted from 2015 to 2019 in Tehran province. In this study, 1220 people were selected by cross-sectional sampling, and blood samples and demographic data were collected by questionnaire. An anti-EBV-VCA ELISA kit was used to determine the seroprevalence of IgG against viral capsid antigen (VCA) among children and adults. In this study, most of the participants were in the age range of 20–29 years (349 individuals). The results of the ELISA test showed that the highest number of positive cases were in people over 40 years (94.8%), 30–39 years (92.5%) and 20–29 years were (92.1%), respectively. On the other hand, the seroprevalence of EBV infection in boys and girls up to 3 years was about 50%, and in adults, up to 40 years, it was about 95% (p < 0.001). The results of this study showed that in Tehran, the seroprevalence of VCA-IgG varied from 70% in primary school children to more than 90% in adults up to 40 years, indicating a broad spread of the virus. The results also indicate that the seroprevalence of EBV is high among men and women in Tehran.

Adult Burkitt lymphoma: An institutional experience with a uniform chemotherapy protocol

Background

Burkitt lymphoma (BL) is treated with short, intensive, noncross resistant multidrug chemotherapy regimens. The management of this aggressive lymphoma is a challenge in our resource-limited setting, and the published data from India is scarce.

Aim

This retrospective study aims to evaluate the clinical features and treatment outcomes in adult patients with BL treated with uniform chemotherapy, cyclophosphamide, vincristine, doxorubicin, methotrexate, ifosfamide, etoposide, cytarabine (CODOX-M/IVAC) protocol (± Rituximab).

Materials and Methods

The hospital records between 2011 and 2017 were reviewed to identify adult patients (age ≥18 years) who were treated with CODOX-M/IVAC protocol (± Rituximab). The demographic and clinical details, treatment, outcomes, and toxicity were recorded from the patient's prospectively maintained case records.

Results

Eighteen patients were included in this study. The median age was 38 years with male:female ratio 3.5:1. The majority of patients were high risk (14/18). All patients had extranodal site of involvement. The treatment completion rate was 83.3%. The overall response rate = 77.8% including complete response rate = 66.7%. Five patients (27%) had progressive disease on therapy. The estimated 2-year overall survival and event-free survival were 73% and 68.4%, respectively. The most common toxicity was myelosuppression (grade v3/4 neutropenia = 88.8%, grade 3/4 thrombocytopenia = 77.7%, and grade 3/4 anemia = 66.6%), febrile neutropenia was seen in 66.6% cases. Most common nonhematological toxicity was mucositis (grd3/4 = 33.3%). No toxic death was seen.

Conclusion

This one of the first retrospective analyses of treatment outcomes from India suggests that our patients are demographically and clinically similar to the western counterpart. The treatment completion rate is high despite significant toxicity. BL has a good outcome if treated adequately.

Comprehensive Transcriptome and Mutational Profiling of Endemic Burkitt Lymphoma Reveals EBV Type-Specific Differences

Endemic Burkitt lymphoma (eBL) is the most common pediatric cancer in malaria-endemic equatorial Africa and nearly always contains Epstein-Barr virus (EBV), unlike sporadic Burkitt lymphoma (sBL) that occurs with a lower incidence in developed countries. Given these differences and the variable clinical presentation and outcomes, we sought to further understand pathogenesis by investigating transcriptomes using RNA sequencing (RNAseq) from multiple primary eBL tumors compared with sBL tumors. Within eBL tumors, minimal expression differences were found based on: anatomical presentation site, in-hospital survival rates, and EBV genome type, suggesting that eBL tumors are homogeneous without marked subtypes. The outstanding difference detected using surrogate variable analysis was the significantly decreased expression of key genes in the immunoproteasome complex (PSMB9/β1i, PSMB10/β2i, PSMB8/β5i, and PSME2/PA28β) in eBL tumors carrying type 2 EBV compared with type 1 EBV. Second, in comparison with previously published pediatric sBL specimens, the majority of the expression and pathway differences was related to the PTEN/PI3K/mTOR signaling pathway and was correlated most strongly with EBV status rather than geographic designation. Third, common mutations were observed significantly less frequently in eBL tumors harboring EBV type 1, with mutation frequencies similar between tumors with EBV type 2 and without EBV. In addition to the previously reported genes, a set of new genes mutated in BL, including TFAP4, MSH6, PRRC2C, BCL7A, FOXO1, PLCG2, PRKDC, RAD50, and RPRD2, were identified. Overall, these data establish that EBV, particularly EBV type 1, supports BL oncogenesis, alleviating the need for certain driver mutations in the human genome.

IMPLICATIONS

Genomic and mutational analyses of Burkitt lymphoma tumors identify key differences based on viral content and clinical outcomes suggesting new avenues for the development of prognostic molecular biomarkers and therapeutic interventions.

Treatment of sporadic Burkitt lymphoma in adults, a retrospective comparison of four treatment regimens

Burkitt lymphoma is an aggressive B cell malignancy accounting for 1–2% of all adult lymphomas. Treatment with dose-intensive, multi-agent chemotherapy is effective but associated with considerable toxicity. In this observational study, we compared real-world efficacy, toxicity, and costs of four frequently employed treatment strategies for Burkitt lymphoma: the Lymphome Malins B (LMB), the Berlin-Frankfurt-Münster (BFM), the HOVON, and the CODOX-M/IVAC regimens. We collected data from 147 adult patients treated in eight referral centers. Following central pathology assessment, 105 of these cases were accepted as Burkitt lymphoma, resulting in the following treatment groups: LMB 36 patients, BFM 19 patients, HOVON 29 patients, and CODOX-M/IVAC 21 patients (median age 39 years, range 14–74; mean duration of follow-up 47 months). There was no significant difference between age, sex ratio, disease stage, or percentage HIV-positive patients between the treatment groups. Five-year progression-free survival (69%, p = 0.966) and 5-year overall survival (69%, p = 0.981) were comparable for all treatment groups. Treatment-related toxicity was also comparable with only hepatotoxicity seen more frequently in the CODOX/M-IVAC group (p = 0.004). Costs were determined by the number of rituximab gifts and the number of inpatients days. Overall, CODOX-M/IVAC had the most beneficial profile with regards to costs, treatment duration, and percentage of patients completing planned treatment. We conclude that the four treatment protocols for Burkitt lymphoma yield nearly identical results with regards to efficacy and safety but differ in treatment duration and costs. These differences may help guide future choice of treatment.

Burkitt lymphoma in adolescents and young adults: management challenges

About one-half of all Burkitt lymphoma (BL) patients are younger than 40 years, and one-third belong to the adolescent and young adult (AYA) subset, defined by an age between 15 and 25-40 years, based on selection criteria used in different reports. BL is an aggressive B-cell neoplasm displaying highly characteristic clinico-diagnostic features, the biologic hallmark of which is a translocation involving immunoglobulin and c-MYC genes. It presents as sporadic, endemic, or epidemic disease. Endemicity is pathogenetically linked to an imbalance of the immune system which occurs in African children infected by malaria parasites and Epstein-Barr virus, while the epidemic form strictly follows the pattern of infection by HIV. BL shows propensity to extranodal involvement of abdominal organs, bone marrow, and central nervous system, and can cause severe metabolic and renal impairment. Nevertheless, BL is highly responsive to specifically designed short-intensive, rotational multiagent chemotherapy programs, empowered by the anti-CD20 monoclonal antibody rituximab. When carefully applied with appropriate supportive measures, these modern programs achieve a cure rate of approximately 90% in the average AYA patient, irrespective of clinical stage, which is the best result achievable in any aggressive lymphoid malignancy to date. The challenges ahead concern the following: optimization of management in underdeveloped countries, with reduction of diagnostic and referral-for-care intervals, and the applicability of currently curative regimens; the development of lower intensity but equally effective treatments for frail or immunocompromised patients at risk of death by complications; the identification of very high-risk patients through positron-emission tomography and minimal residual disease assays; and the assessment in these and the few refractory/relapsed ones of new monoclonals (ofatumumab, blinatumomab, inotuzumab ozogamicin) and new molecules targeting c-MYC and key proliferative steps of B-cell malignancies.

2016 US lymphoid malignancy statistics by World Health Organization subtypes

Collectively, lymphoid neoplasms are the fourth most common cancer and the sixth leading cause of cancer death in the United States. The authors provide contemporary lymphoid neoplasm statistics by subtype based on the 2008 World Health Organization classifications, including the most current US incidence and survival data. Presented for the first time are estimates of the total numbers of US lymphoid neoplasm cases by subtype as well as a detailed evaluation of incidence and survival statistics. In 2016, 136,960 new lymphoid neoplasms are expected. Overall lymphoma incidence rates have declined in recent years, but trends vary by subtype. Precursor lymphoid neoplasm incidence rates increased from 2001 to 2012, particularly for B-cell neoplasms. Among the mature lymphoid neoplasms, the fastest increase was for plasma cell neoplasms. Rates also increased for mantle cell lymphoma (males), marginal zone lymphoma, hairy cell leukemia, and mycosis fungoides. Like incidence, survival for both mature T-cell lymphomas and mature B-cell lymphomas varied by subtype and by race. Patients with peripheral T-cell lymphomas had among the worst 5-year relative survival (36%-56%, depending on race/sex), while those with mycosis fungoides had among the best survival (79%-92%). For B-cell lymphomas, 5-year survival ranged from 83% to 91% for patients with marginal zone lymphoma and from 78% to 92% for those with hairy cell leukemia; but the rates were as low as 47% to 63% for patients with Burkitt lymphoma and 44% to 48% for those with plasma cell neoplasms. In general, black men had the lowest survival across lymphoid malignancy subtypes. These contemporary incidence and survival statistics are useful for developing management strategies for these cancers and can offer clues regarding their etiology. CA Cancer J Clin 2016;66:443-459. © 2016 American Cancer Society.

Peripheral blood lymphocyte to monocyte ratio identifies high-risk adult patients with sporadic Burkitt lymphoma

Adult sporadic Burkitt lymphoma (BL) is a rare subtype of lymphoma. In this retrospective study, we investigated the prognostic value of pretreatment lymphocyte to monocyte ratio (LMR) in a cohort of 62 patients. Using LMR <2.6 as the optimal cutoff point, 24 patients (38.7 %) had LMR <2.6. The complete response rates in high-LMR group and low-LMR group were 90.9 and 65.0 %, respectively (P = 0.019). At a median follow-up time of 41 months, the 3-year progression-free survival (PFS) rate and overall survival (OS) rates were 76 and 80 %, respectively. In a multivariate Cox regression model, it was found that the presence of bone marrow infiltration and low LMR were independently adverse prognostic factors for both PFS and OS. In the whole group, the addition of rituximab to treatment did not benefit patients significantly in PFS and OS. In subgroup analysis, in patients with high LMR, addition of rituximab can significantly improve survival outcomes (P = 0.046). In conclusion, we firstly found that low LMR (<2.60) was an independently adverse prognostic factor in adult patients with sporadic BL. Intensive chemotherapy could cure the majority of patients in our study, and the pretreatment LMR might predict the value of rituximab in this age population.

Medical history, lifestyle, family history, and occupational risk factors for sporadic Burkitt lymphoma/leukemia: the Interlymph Non-Hodgkin Lymphoma Subtypes Project

BACKGROUND

The etiologic role of medical history, lifestyle, family history, and occupational risk factors in sporadic Burkitt lymphoma (BL) is unknown, but epidemiologic and clinical evidence suggests that risk factors may vary by age.

METHODS

We investigated risk factors for sporadic BL in 295 cases compared with 21818 controls in a pooled analysis of 18 case-control studies in the International Lymphoma Epidemiology Consortium (InterLymph). Cases were defined to include typical BL or Burkitt-like lymphoma. Odds ratios (ORs) and 95% confidence intervals (CIs) for associations were calculated separately for younger (<50 years) and older (≥ 50 years) BL using multivariate logistic regression.

RESULTS

Cases included 133 younger BL and 159 older BL (age was missing for three cases) and they were evenly split between typical BL (n = 147) and Burkitt-like lymphoma (n = 148). BL in younger participants was inversely associated with a history of allergy (OR = 0.58; 95% CI = 0.32 to 1.05), and positively associated with a history of eczema among individuals without other atopic conditions (OR = 2.54; 95% CI = 1.20 to 5.40), taller height (OR = 2.17; 95% CI = 1.08 to 4.36), and employment as a cleaner (OR = 3.49; 95% CI = 1.13 to 10.7). BL in older participants was associated with a history of hepatitis C virus seropositivity (OR = 4.19; 95% CI = 1.05 to 16.6) based on three exposed cases. Regardless of age, BL was inversely associated with alcohol consumption and positively associated with height.

CONCLUSIONS

Our data suggest that BL in younger and older adults may be etiologically distinct.

Global burden of deaths from Epstein-Barr virus attributable malignancies 1990-2010

Background

Epstein-Barr virus (EBV) is an oncogenic virus implicated in the pathogenesis of a number of human malignancies of both lymphoid and epithelial origin. Thus, a comprehensive and up-to-date analysis focused on the global burden of EBV-attributable malignancies is of significant interest.

Methods

Based on published studies, we estimated the proportion of Burkitt’s lymphoma (BL), Hodgkin’s lymphoma (HL), nasopharyngeal carcinoma NPC), gastric carcinoma (GC) and post-transplant lymphoproliferative disease (PTLD) attributable to EBV, taking into consideration age, sex and geographical variations. This proportion was then imputed into the Global Burden of Disease 2010 dataset to determine the global burden of each EBV-attributable malignancy in males and females in 20 different age groups and 21 world regions from 1990 to 2010.

Results

The analysis showed that the combined global burden of deaths in 2010 from all EBV-attributable malignancies was 142,979, representing 1.8% of all cancer deaths. This burden has increased by 14.6% over a period of 20 years. All 5 EBV-attributable malignancies were more common in males in all geographical regions (ratio of 2.6:1). Gastric cancer and NPC accounted for 92% of all EBV-attributable cancer deaths. Almost 50% of EBV-attributed malignancies occurred in East Asia. This region also had the highest age-standardized death rates for both NPC and GC.

Conclusions

Approximately 143,000 deaths in 2010 were attributed to EBV-associated malignancies. This figure is likely to be an underestimate since some of the less prevalent EBV-associated malignancies have not been included. Moreover, the global increase in population and life-expectancy will further increase the overall burden of EBV-associated cancer deaths. Development of a suitable vaccine could have a substantial impact on reducing this burden.

Electronic supplementary material

The online version of this article (doi:10.1186/1750-9378-9-38) contains supplementary material, which is available to authorized users.

How I treat Burkitt lymphoma in adults

Burkitt lymphoma (BL) is an aggressive B-cell non-Hodgkin lymphoma that is almost uniformly associated with translocations involving the gene for MYC on chromosome 8. The 3 subtypes of BL, endemic, sporadic, and immunodeficiency-associated, differ from epidemiologic and clinical perspectives but may be genetically similar. Prompt administration of multiagent immunochemotherapy regimens is associated with favorable outcomes for the majority of patients. Survival is inferior in older patients, likely reflecting increased therapy-related toxicity, possibly resulting in decreased treatment intensity. Central nervous system prophylaxis, tumor lysis prevention and treatment, and management of infectious complications from myelosuppressive regimens are critical. Prognosis of refractory or relapsed disease is poor and patients are best treated on clinical trials when available.

The role of EBV in the pathogenesis of Burkitt's Lymphoma: an Italian hospital based survey

The exact worldwide incidence of Burkitt’s lymphoma is not known. There are three distinct clinical variants of Burkitt’s lymphoma, each manifesting differences in epidemiology, clinical presentation, morphology, biology and genetic features: the endemic (African), the sporadic (non-endemic), and the immunodeficiency-associated form. In particular, we reported data regarding Burkitt’s lymphoma incidence in the world and across different European countries. Finally, we described clinic-pathological data of 48 Burkitt’s lymphomas occurred in Italy from 2003 to 2013, in 4 different hospitals, two of which located in east side, and the other ones located in the west-coast. Forty Burkitt’s lymphomas occurs in children (age range 3–12), and 8 were adulthood Burkitt’s lymphomas (age range 18–87). In the pediatric group the Male:Female ratio (M:F) was of 4:1, whereas the group of the adult patients has a M:F of 1:1.67. Immunohistochemical detection of Latent Membrane Protein 1 (LMP1) expression and Epstein-Barr virus Encoded RNA (EBER) In Situ Hybridization (ISH) procedures have been performed. Lymphocyte B monoclonal spread has been demonstrated using a Polymerase Chain Reaction (PCR) based method to amplify Fragment Restriction FR1, FR2 and FR3 immunoglobulin heavy chains DNA fragments. Only 38 cases out of 48 were analyzed for LMP-1 showing various percentage of stained cells in 47.4% of the patients.

Considering ISH for EBER detection results:

1 out 2 (50%) adult analyzed cases was positive, with 50% of stained tumor cells (this patient was a 22 years old female, coming from Napoli);

15 out 24 (62.5%) children analyzed Burkitt’s lymphomas resulted as positive for EBER;

the overall positivity has been observed in 16/26 Burkitt’s lymphomas (61.53%).

Finally, EBV has been detected in children and adult patients, one of them with deregulation of the oncogene c-MYC by chromosomal translocation.

Disease patterns of pediatric non-Hodgkin lymphoma: A study from a developing area in Egypt

Non-Hodgkin lymphoma (NHL) accounts for 8-10% of all childhood cancers. NHL collectively represents various lymphoid malignancies with diverse clinicopathological and biological characteristics. In this study, we aimed to describe the epidemiological and clinicopathological characteristics and treatment outcomes of pediatric NHL patients treated at the Pediatric Oncology Unit of Zagazig University Hospital and the Benha Specialized Pediatric Hospital. We conducted a cross-sectional retrospective study by reviewing the medical records of 142 patients admitted with a diagnosis of NHL over a period of 8 years (February, 2004 to February, 2012) in these two Oncology Units. The age at presentation ranged between 2 and 15 years, with a mean ± standard deviation (SD) of 6.1±2.8 years and a male:female ratio of 1.7:1. Abdominal involvement was the most common presentation (73.2%). Burkitt's lymphoma (BL) was the most common NHL subtype (69%), followed by lymphoblastic lymphoma, diffuse large B-cell lymphoma and anaplastic large-cell lymphoma, accounting for 18.3, 10.6 and 2.1% of the cases, respectively. The majority of the patients (88.7%) had been diagnosed with advanced disease (Murphy stage III/IV). Complete remission was achieved in 120 cases (84.5%). A total of 16 patients (11.3%) succumbed to the disease during the first few months and 6 patients (4.2%) remained alive following relapse. The mean follow-up duration ± SD was 34.6±25.1 months (range, 3-84 months). The 5-year overall survival (OS) and event-free survival (EFS) rates were 88.7 and 85.1%, respectively. None of the clinical, epidemiological or pathological variables exhibited a statistically significant association with the OS or EFS. In conclusion, NHL occurs at a younger age, with a higher incidence of BL and advanced-stage disease. The outcome of NHL in our two centers was satisfactory, approaching the international rates.

Seasonality of Burkitt's lymphoma in Uganda

BACKGROUND/AIMS

Burkitt's lymphoma is the most common childhood oral maxillofacial tumor in Africa and some studies have reported seasonal variation.

MATERIALS AND METHODS

All Burkitt's cases diagnosed from 1969 to 2006, from all over Uganda, at the Makerere University's Department of Pathology, were analyzed, to determine seasonal variation. This was done by evaluation of monthly and rainy versus dry season prevalence.

STATISTICAL ANALYSIS

The Wilcoxon test was used in both cases, to assess the statistical significance of differences in the diagnostic rates of Burkitt's lymphoma, in comparison to nonspecific chronic inflammation, using the total as the denominator. Yearly variation in prevalence was examined by a Chi-square test for linear trend. Mann-Whitney tests were done to compare the climatic regions. Multivariate analysis of variance (MANOVA) was used to test for differences when gender, seasons and climatic regions were factored in.

RESULTS

Although monthly frequencies varied considerably over the period, none of the differences were statistically significant (Pearson's 15.199, degrees of freedom df = 11, P = 0.174). Likewise, there was no statistically significant difference in the total number of Burkitt's and nonspecific chronic inflammation biopsies handled at the Department during the rainy and dry seasons.

CONCLUSION

Although the 38-year period gave us sufficient numbers to use the Edward's method for seasonality, it also meant that a lot of seasonal changes that occurred during the period were not taken into consideration. We hence feel that a review of this data with weather experts, so as to group the biopsies into accurate rainfall and dry patterns, would yield a more authoritative publication.

Burkitt lymphoma: epidemiological features and survival in a South African centre

BACKGROUND

The epidemiology of Burkitt Lymphoma (BL) shows that the endemic type is mainly confined to equatorial Africa and has a very close association with the Epstein-Barr virus (EBV), while the sporadic variant shows only a 20% association with EBV and is seen mainly in Europe and North America. An immunodeficent form of BL has been described more recently. This study aimed to describe the epidemiological characteristics and survival of children presenting with BL to Tygerberg Hospital, Cape Town, in South Africa.

METHODS

A retrospective, descriptive study reviewed all pediatric cases of Burkitt lymphoma at Tygerberg Hospital Oncology Unit between 1 January 1995 and 31 December 2010. The following data were analysed: age at diagnosis, gender, anatomic site, race, socio-economic demographic (rural vs. urban), treatment protocol, side effects, viral characteristics and survival. All cases were confirmed by histology and reviewed by a tumour board.

RESULTS

A total of 51 patients with Burkitt lymphoma were analysed from 1995 to 2010. Their age ranged from 2 to 14 years (mean of 6.8 years).The male to female ratio was 3.6/1. Most of the patients lived in an urban setting (52.9%). The initial presenting tumour site was abdominal in most cases (76.4%). The majority of patients (90%) were treated with the LMB protocol. Neutropenic sepsis, mucositis and gastroenteritis were the top 3 side effects while receiving therapy (58.8%, 50.9% and 31.3% respectively). The overall survival rate was 64.7%. A documented positive HIV1 test was found in 11% of the total number of patients. The stage of the disease at the time of presentation strongly influenced the outcome with only 41.6% of stage 4 patients surviving (p = 0.03).

CONCLUSIONS

The patients seen at Tygerberg Hospital, South Africa presented typically with the sporadic variant of Burkitt Lymphoma. The patients presented with large abdominal masses and in an advanced stage of the disease.

Burkittts lymphoma revisited: series of three cases with varied clinical presentation

Burkitt's lymphoma is a form of non-Hodgkin's B-cell lymphoma with more than one identifiable variant. This tumour was first noted in Africans. The sporadic form most commonly presents with abdominal lymph node involvement. This tumour predominently affects children and is probably the fastest growing tumours in humans, with exuberant proliferation. We here in report on three patients from our experience both adult and children who presented with varied clinical features.

Androgen receptor function links human sexual dimorphism to DNA methylation

Sex differences are well known to be determinants of development, health and disease. Epigenetic mechanisms are also known to differ between men and women through X-inactivation in females. We hypothesized that epigenetic sex differences may also result from sex hormone functions, in particular from long-lasting androgen programming. We aimed at investigating whether inactivation of the androgen receptor, the key regulator of normal male sex development, is associated with differences of the patterns of DNA methylation marks in genital tissues. To this end, we performed large scale array-based analysis of gene methylation profiles on genomic DNA from labioscrotal skin fibroblasts of 8 males and 26 individuals with androgen insensitivity syndrome (AIS) due to inactivating androgen receptor gene mutations. By this approach we identified differential methylation of 167 CpG loci representing 162 unique human genes. These were significantly enriched for androgen target genes and low CpG content promoter genes. Additional 75 genes showed a significant increase of heterogeneity of methylation in AIS compared to a high homogeneity in normal male controls. Our data show that normal and aberrant androgen receptor function is associated with distinct patterns of DNA-methylation marks in genital tissues. These findings support the concept that transcription factor binding to the DNA has an impact on the shape of the DNA methylome. These data which derived from a rare human model suggest that androgen programming of methylation marks contributes to sexual dimorphism in the human which might have considerable impact on the manifestation of sex-associated phenotypes and diseases.

Burkitt lymphoma mimicking acute pancreatitis

Burkitt lymphoma (BL) is a highly aggressive B cell lymphoma, presenting in extranodal sites or as an acute leukemia. Three clinical variants of BL are recognized: endemic BL, sporadic BL and immunodeficiency associated BL. Sporadic BL is seen worldwide, mainly in children and young adults involving the abdominal organs mostly the ileocaecal area. Pancreatic involvement is rare. The authors report a unique case of abdominal Burkitt lymphoma, initially diagnosed and treated as acute pancreatitis. Clinically, the patient presented severe abdominal pain and vomiting. Imaging findings were suggestive of inflammatory involvement of the pancreas, heading treatment towards this hypothesis. Unfortunately, the patient died during the diagnostic work up, and the autopsy findings demonstrated advanced Burkitt lymphoma with extensive involvement of pancreatic parenchyma and other organs within the abdominal cavity. Once Burkitt lymphoma is a potentially curable disease, early diagnosis is crucial for better outcomes.

Successful Management of Jejunal Perforation in Burkitt's Lymphoma: A Case Report

Burkitt's lymphoma (BL) is rare, rapidly growing, and highly aggressive. Urgent commencement of chemotherapy is vital to prevent complications and promote a favourable prognosis. Any factor causing a delay in the initiation of chemotherapy will affect prognosis significantly. Intestinal perforation is a well-known complication with devastating consequences. It inevitably leads to a delay in the initiation of chemotherapy. There are few reports in the literature that discuss this complication. Furthermore, there are no reports of patients that have survived intestinal perforation occurring prior to the commencement of chemotherapy. We present a case of a 55-year-old male who survived perforation of advanced sporadic BL of the jejunum occurring prior to the commencement of chemotherapy. Critical aspects of the patients care are discussed.

Primary Burkitt's lymphoma of the colon--an uncommon cause of acute constipation and abdominal pain

Constipation is a common problem in children and adolescents, accounting for over 25% of all visits to pediatric gastroenterologists. Approximately 95% of childhood constipation is functional in nature. Primary gastrointestinal malignancies are rare in childhood and adolescence. When present in the gastrointestinal tract, Burkitt's lymphoma is typically located in the ileocecal region. We present a case of primary Burkitt's lymphoma of the transverse colon in an adolescent presenting with acute exacerbation of constipation, abdominal pain, and later, rectal bleeding and progressive weight loss.

Sporadic Burkitt lymphomas of children and adolescents in Chinese: a clinicopathological study of 43 cases

Background

To investigate the clinical and pathologic features as well as the MYC translocations of childhood Burkitt lymphoma (BL) from China.

Methods

Fourty-three cases of childhood BL were retrospectively investigated in morphology, immunophenotype, genotype, treatments and survival analysis.

Results

Clinically, there was a marked male predominance in sex distribution (M: F = 9.75:1); abdomen was the most frequent extranodal sites of involvement (46.5 %), followed by jaws and facial bones (16.3 %). Two third of the patients were in stageI ~ II. Morphologically, 69.76 % of the cases showed classical histologic features, while 30.24 % of them showed greater nuclear pleomorphism in size and shape. Five cases (11.6 %) were positive for EBER1/2. Thirty-one of the 40 cases (77.5 %) had the aberration of IGH/MYC translocation while 7 (17.5 %) had non-IGH/MYC translocation. Thirty patients (69.7 %) received operation and/or chemotherapy while 13 patients (30.3 %) received no treatment. Twenty-seven patients (62.8 %) died of the tumor, 16 alive, with the average survival time 4.9 and 48.7 months respectively. High IPI, advanced clinical stage, increased serum level of LDH and no chemotherapy received as well as tumor size ≥10 cm were related to the lower survival rates of the tumor.

Conclusions

Several differences were showed in this group of BL, including a much higher ratio of male patients, more cases in stageII, clinically inconsistent treatment and a very poor outcome.

Virtual slides

The virtual slide(s) for this article can be found here http://www.diagnosticpathology.diagnomx.eu/vs/1552295877710135

Sporadic Burkitt lymphoma in southern China: 12 years' experience in a single institution in Guangzhou

Aim

To analyse the clinicopathological features of sporadic Burkitt lymphoma (sBL).

Methods

In a review of 1682 cases of non-Hodgkin lymphoma diagnosed in the First Affiliated Hospital and Zhongshan School of Medicine, from 1998 to 2010, 20 cases (1.2%) of sBL were identified. Histopathological examination, immunohistochemistry and in situ hybridisation were used to analyse the clinicopathological features of these cases.

Results

Of the 20 cases of sBL, 18 patients were male and two were female. The mean age was 18 years (range 2–67 years). Extranodal presentation was more common than nodal presentation (55% vs 15%). Histopathologically, 18 cases (90%) showed monotonous medium-sized tumour cells, and two cases showed cells that were slightly pleomorphic in nuclear size and shape. Immunophenotypically, MUM1 was positive in three of 17 cases (17.6%). EBER expression was shown in five of 17 cases (29.4%), and all EBER-positive sBLs were Bcl-6+/MUM1−.

Conclusion

sBL is rare and mainly affects male children, with predominantly extranodal presentation. MUM1 expression was found in some sBLs. EBER expression was found in 29.4% of sBLs from southern China, an area with a well-known high incidence of nasopharyngeal carcinoma, which is closely associated with Epstein–Barr virus infection.

Disorders of sex development expose transcriptional autonomy of genetic sex and androgen-programmed hormonal sex in human blood leukocytes

BACKGROUND

Gender appears to be determined by independent programs controlled by the sex-chromosomes and by androgen-dependent programming during embryonic development. To enable experimental dissection of these components in the human, we performed genome-wide profiling of the transcriptomes of peripheral blood mononuclear cells (PBMC) in patients with rare defined "disorders of sex development" (DSD, e.g., 46, XY-females due to defective androgen biosynthesis) compared to normal 46, XY-males and 46, XX-females.

RESULTS

A discrete set of transcripts was directly correlated with XY or XX genotypes in all individuals independent of male or female phenotype of the external genitalia. However, a significantly larger gene set in the PBMC only reflected the degree of external genital masculinization independent of the sex chromosomes and independent of concurrent post-natal sex steroid hormone levels. Consequently, the architecture of the transcriptional PBMC-"sexes" was either male, female or even "intersex" with a discordant alignment of the DSD individuals' genetic and hormonal sex signatures.

CONCLUSION

A significant fraction of gene expression differences between males and females in the human appears to have its roots in early embryogenesis and is not only caused by sex chromosomes but also by long-term sex-specific hormonal programming due to presence or absence of androgen during the time of external genital masculinization. Genetic sex and the androgen milieu during embryonic development might therefore independently modulate functional traits, phenotype and diseases associated with male or female gender as well as with DSD conditions.

Diffuse aggressive B-cell lymphomas

Diffuse aggressive B-cell lymphomas comprise a relatively common and increasingly diverse group of neoplasms. Newer modalities including gene expression profiling and an increasing panel of immunohistochemical markers have contributed to greater accuracy in defining these entities. Attention is paid not only to the neoplastic cells but also to the cellular and stromal milieu in which they proliferate. These distinctions may have therapeutic implications as well, with improved outcome related to newer and sometimes targeted therapies. At the same time there is increasing understanding of the overlap, which occurs in the grey zone between diffuse large B-cell lymphoma and Burkitt lymphoma as well as between diffuse large B-cell lymphoma and Hodgkin lymphoma. This review aims to provide practical insights in the correct identification and differential diagnosis of these lymphomas, with emphasis on the changes that have occurred with the publication of the 2008 World Health Organization updated classification.

Burkitt lymphoma in Brazil is characterized by geographically distinct clinicopathologic features

Burkitt lymphoma (BL) is a highly aggressive non-Hodgkin lymphoma with a consistent MYC translocation. Epstein-Barr virus (EBV) has been associated with BL at different frequencies, depending on the clinical variant and geographic regions. This is a large-scale study of BL in Brazil, including 234 patients from 5 geographic regions that are widely disparate socioeconomically, including pediatric (61.1%) and adult (37.6%) populations. EBV was present in 52.6% of all BL cases, varying from 29% (12/42) in the South to 76% (13/17) in the North. Most of the cases were EBV type A. The frequency was higher in the pediatric group, and EBV association within this age range predominated in all regions except the South. Expression of p53 protein was observed in 16.2%, and only rare cases showed p63 expression. BL in Brazil is regionally distinct and has a low incidence of p53 overexpression and a higher-than-expected association with EBV in sporadic cases.

Oral Burkitt's lymphoma--case report

Burkitt's lymphoma is a poorly differentiated rare and aggressive type of non-Hodgkin's lymphoma. This article reports the case of a male child aged seven years, who was examined at the Odontopediatric Clinic of the UFRN Dentistry Department. The patient presented a tumor in the premolar region of the mandible; teeth were mobile in this region. Radiology revealed a diffuse radioluscent area which was diagnosed histopathologically as Burkitt's lymphoma. The patient was treated with polychemotherapy; complete remission of the disease was attained.

Imaging of pediatric lymphomas

Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) represent 10% to 15% of all malignancies occurring in children younger than 20 years of age. Advances in cross-sectional imaging and the availability of positron emission tomography (PET) and PET-CT have had a major impact on imaging and management of pediatric patients. This article reviews the clinical features of lymphoma, focusing on the spectrum of imaging findings seen in diagnosis, staging, and follow-up of HL and NHL. Pediatric NHL has four major histologic subtypes: Burkitt lymphoma, diffuse large B-cell lymphoma, anaplastic large cell lymphoma, and lymphoblastic lymphoma. The most important subtype of HL is nodular sclerosis.

Molecular profiling of pediatric mature B-cell lymphoma treated in population-based prospective clinical trials

The spectrum of entities, the therapeutic strategy, and the outcome of mature aggressive B-cell non-Hodgkin lymphomas (maB-NHLs) differs between children and adolescents on the one hand and adult patients on the other. Whereas adult maB-NHLs have been studied in detail, data on molecular profiling of pediatric maB-NHLs are hitherto lacking. We analyzed 65 cases of maB-NHL from patients up to 18 years of age by gene expression profiling, matrix comparative genomic hybridization (CGH), fluorescent in situ hybridization (FISH), and immunohistochemistry. The majority of the analyzed pediatric patients were treated within prospective trials (n = 49). We compared this group to a series of 182 previously published cases of adult maB-NHL. Gene expression profiling reclassified 31% of morphologically defined diffuse large B-cell lymphomas as molecular Burkitt lymphoma (mBL). The subgroups obtained by molecular reclassification did not show any difference in outcome in children treated with the NHL-Berlin-Frankfurt-Muenster (BFM) protocols. No differences were detectable between pediatric and adult mBL with regard to gene expression or chromosomal imbalances. This is the first report on molecular profiling of pediatric B-NHL showing mBL to be much more prominent in children than suggested by morphologic assessment. Based on molecular profiling mBL is a molecularly homogeneous disease across children and adults.

Linfoma de Burkitt oral: relato de caso

O linfoma de Burkitt é um raro e agressivo tipo de linfoma não-Hodgkin pobremente diferenciado. O presente relato trata de uma criança do sexo masculino, com sete anos de idade, que foi examinada na Clínica de Odontopediatria do Departamento de Odontologia da UFRN, exibindo uma massa tumoral na região de pré-molares mandibulares com mobilidade dentária. O exame radiográfico revelou uma área radiolúcida difusa e o diagnóstico histopatológico foi de linfoma de Burkitt. O paciente foi tratado por poliquimioterapia e obteve completa remissão da patologia.

Biologic features and treatment outcome of secondary acute lymphoblastic leukemia--a review of 101 cases

BACKGROUND

Secondary acute lymphoblastic leukemia (sALL) is a rare disease and its biologic features are not well characterized.

PATIENTS AND METHODS

We describe a cohort of seven patients and discuss 94 additional cases from the literature for whom biological parameters were described. Cases with incomplete data were excluded.

RESULTS

Hodgkin's disease (HD) was more common in the 18-59 age group while breast and prostate cancers were prevalent only in the >or=18-year-old patients. The time interval to develop sALL was similar among all age groups but was significantly longer for HD and neuroblastoma primary diagnoses and sALL with complex karyotype. T-cell immunophenotype was more common in the <18 age group. Complete remission was infrequent in the >or=60 age group. The overall survival was poor for all sALL regardless of age, primary diagnoses, cytogenetic subgroups, or immunophenotype. Allogeneic transplantation most probably represents the only chance of cure.

CONCLUSION

Better identification of prognostic factors to prevent the occurrence of sALL is indicated.

Burkitt's lymphoma: clinicopathologic features and differential diagnosis

Burkitt's lymphoma is a highly aggressive lymphoma identified and described in the last century by Denis Burkitt in Africa, in areas endemic for malaria. Since its description in African children, it has been recognized outside areas with endemic malaria, frequently also in children as well as among individuals with an underlying immunodeficiency. Since its initial designation as Burkitt's lymphoma, this type of lymphoma and lymphomas closely resembling it have received a variety of names in different classifications of lymphomas and leukemias: undifferentiated lymphoma, Burkitt's and non-Burkitt's type in the modified Rappaport Classification, malignant lymphoma, small non-cleaved cell, Burkitt's type in the Working Formulation, Burkitt's lymphoma and high-grade B-cell lymphoma, Burkitt-like in the REAL Classification, and acute lymphoblastic leukemia, L3 type in the FAB Classification. With the publication of the WHO Classification of Haematopoietic and Lymphoid Tumors, the nomenclature of this lymphoma has come full circle, and it is once again known simply as Burkitt's lymphoma. In recent years, efforts have focused on improving therapy for this rapidly proliferating neoplasm while minimizing, to the extent possible, treatment-associated toxicity. These efforts have led to the development of high-intensity, short-duration combination chemotherapy that has proven extremely effective for a high proportion of Burkitt's lymphoma patients. The differential diagnosis of Burkitt's lymphoma is broad, and precise diagnosis based on histologic, immunophenotypic, and genetic features remains the critical first step in planning appropriate therapy.

Prognostic factor analysis and proposed prognostic model for conventional treatment of high-grade primary gastric lymphoma

OBJECTIVES

We conducted a clinical risk factors analysis to define a prognostic model for high-grade primary gastric lymphoma (HG-PGL).

METHODS AND RESULTS

The median event-free survival and overall survival of 214 HG-PGL patients were 54 and 104.5 months, respectively, after a median follow-up duration of 60 months. According to the prognostic factor analysis, survival, advanced age, male gender, higher LDH levels and the presence of ascites were identified as independent prognostic factors for HG-PGL. We identified four groups at different risk: group 1, no adverse effect; group 2, one factor; group 3, two factors; group 4, three or four factors. The new prognostic model showed excellent prognostic capacity to differentiate subgroups according to their risk stratification.

CONCLUSIONS

The proposed new prognostic model for HG-PGL demonstrated a balanced distribution of patients into four groups with good prognostic capacity.

Spinal Burkitt's lymphoma in adults

Adult Burkitt's lymphoma is an uncommon disease. Few cases of spinal involvement in adults with sporadic Burkitt's lymphoma are reported in the literature. We present a case of a middle-aged man who was found to have an epidural mass in the thoracic spine when investigated for back pain and lower extremity weakness. He underwent a laminectomy with resection of the epidural mass. Histologic examination revealed a primary Burkitt's lymphoma of the spinal cord. He was treated with aggressive chemotherapy and is now experiencing remission of his disease. We also present a review of the literature for the etiology and clinical features of other spinal lymphomas and Burkitt's lymphoma involving the spine in adults.