Burkitt lymphoma linked to virus
DEAR DOCTOR: Could you tell me about the causes, treatment and remission rates for Burkitt lymphoma?
DEAR READER: Burkitt lymphoma is a highly aggressive, rapidly growing type of B cell lymphoma. It’s caused by an alteration to a gene involved with cell division and cell death. The alteration of this gene causes B cell lymphocytes (a type of white blood cell) to divide quickly and repeatedly, creating multiple abnormal cells.
There are three types of Burkitt lymphoma, and the likelihood of each one depends on your geographic region and your immune status. In Africa, the incidence of Burkitt lymphoma is 50 times higher than in the United States, with the disease there caused largely by chronic Epstein-Barr virus infection. In this type of Burkitt lymphoma, the peak incidence of infection is between the ages of 4 and 7. Often, the disease is initially found in the bones of the face or jaw; from there it can spread to other parts of the body.
The most common type of Burkitt lymphoma in the United States
is much rarer — about three cases per million people per year — and the peak incidence is about 11 years of age, with the majority of cases occurring in people younger than 35.
The third type of Burkitt lymphoma occurs in people with a suppressed immune system, usually due to HIV infection. In these cases, the suppression of the immune system causes viruses, like Epstein-Barr, to exert genetic changes on B cells that lead to lymphoma.
Because Burkitt lymphoma is a rapidly growing cancer, chemotherapy works well against it, and multiple drugs are available to stop its growth and destroy the rapidly growing B cells. In fact, because drugs are so effective, radiation and surgery are not generally recommended. Of note, many chemotherapy regimens now include the medication Rituxan, often used for rheumatoid arthritis, because of its ability to attack B lymphocytes. Because Burkitt lymphoma can often make its way to the brain, most chemotherapy treatments are also given via the cerebrospinal fluid by way of a lumbar puncture.