Burkitt's

Question 1

What are the 3 variants of Burkitt’s Lymphoma?

Answer 1

1) Endemic
- a/w EBV, Equatorial Africa
2) Sporadic 1%
3) Immunodeficiency related

Question 2

What is the diagnostic criteria for Burkitt’s ?

Answer 2

CD20+
CD10+
BCL-6+
CD43+

BCL2-
CD5-

Ki67 >95%

Question 3

What is the diagnostic criteria for Double-hit lymphomas?

Answer 3

CD20+
BCL2+
CD43+

BCL6+/-
CD10+/-
CD5+/-

Ki67>90%

Question 4

What cytogenetics do you know about Burkitt’s?

Answer 4

80% of BL has t(8;14)
- juxtaposition of c-myc gene on chromosome 8 with IgH enhancer elements on chr 14

20% of BL cases:

• t(2;8)(p12;q24)
• t(8;22)(q24;q11)

Question 5

What are the possible treatments for Burkitt’s Lymphoma?

Answer 5

1) Standford Regimen
2) CODOX-M
3) CODOX-M/IVAC
4) Hyper-CVAD
5) LMP 84,86 and 89
6) BNHL-86
7) CALGB 9251

Question 6

What is the Standford Regimen made up of?

Answer 6

Cyclophosphamide 1200 mg/m2 D1
Doxorubicin 40 mg/m2 D1
Vincristine 1.4mg/m2 (max 2 mg) D1
Prednisone 40mg/m2 D1-5
MTX 3000 mg/m2 (with Leucovorin rescue) D10
IT MTX 12mg D1 and D10

Question 7

What are the NCCN suggested treatments?

Answer 7

CHOP is not adequate therapy

Combination therapy required

Low Risk:
- CALGB 10002 Regimen
- CODOX-M (original or modified)
- DA-REPOCH
>> Regimen includes IT MTX)
>> minimum 3 cycles with one additional cycle beyond CR 
- HyperCVAD

High Risk:
- CALGB 10002 Regimen
>> prophylactic CNS irradiation in select patients 
- CODOX-M (original or modified)
>> alternating with IVAC 
- DA-REPOCH
- HyperCVAD 

2nd-line Therapy: (Select pts with reasonable remission)

• No definitive 2nd-line therapies*
• DA-REPOCH (minimum 3 cycles with one additional cycle beyond CR)
• RICE + IT MTX if not given previously
• RIVAC + IT MTX if not given previously
• RGDP
• High-dose Cytarabine + RItuximab

Question 8

What are the Laboratory hallmarks for TLS?

Answer 8

High potassium
High uric acid
High phosphorous
Low calcium

Question 9

What are the high-risk features for TLS?

Answer 9

Burkitt’s Lymphoma, Lymphoblastic Lymphoma
Occ DLBCL, CLL
Spontaneous TLS
Elevated WBC
BM involvement
Ineffectiveness of allopurinol
Renal disease or renal involvement by tumor

Question 10

When is Rasburicase indicated?

Answer 10

Presence of any high-risk features
Urgent need to initiate therapy in a high-bulk patient
Situations where adequate hydration may be difficult or impossible
ARF

Question 11

What is the danger of TLS?

Answer 11

ARF
Cardiac arrhythmias
Seizures
Loss of muscle control
Death

Question 12

How to dose Rasburicase?

Answer 12

One dose usually enough
3-6mg usually effective

Redosing should be individualized

Question 13

What are the antiviral options available?

Answer 13

Entecavir (preferred)
Avoid Lamivudine due to resistance development 
Adefovir 
Telbivudine
Tenofovir

Question 14

How long to maintain prophylaxis for ? For Hep B

Answer 14

12 months after oncological treatment ends

But need to consult hematologist for duration if active HBV