Burkitt's Lymphoma in Africa; a Review of the Epidemiology and Etiology

Burkitt's lymphoma (BL) was first described in Eastern Africa; initially thought to be a sarcoma of the jaw. Shortly it became well known that this was a distinct form of Non Hodgkin's lymphoma.The disease has given insight in all aspects of cancer research and care. Its peculiar epidemiology has led to the discovery of Epstein Barr virus (EBV) and its importance in the cause of several viral illnesses and malignancies.The highest incidence and mortality rates of BL are seen in Eastern Africa. BL affects mainly children; and boys are more susceptible than girls. Evidence for a causal relationship between EBV and BL in the endemic form is fairly strong. Frequency of association between EBV and BL varies between different patient groups and different parts of the world. EBV may play a role in the pathogenesis of BL by deregulation of the oncogene c-MYC by chromosomal translocation.Although several studies suggest an association between malaria and BL; there has never been a conclusive population study in support of a direct role of malaria in causation of BL.The emergence of HIV and a distinct subtype of BL in HIV infected have brought a new dimension to the disease particularly in areas where both HIV and BL are endemic. BL has been reported as a common neoplasmin HIV infected patients; but not in other forms of immuno-depression; and the occurrence of BL seems to be higher amongst HIV positive adults; while the evidence of an association amongst children is still disputed.The role of other possible risk factors such as low socio-economical status; exposure to a plant species common in Africa called Euphorbiaceae; exposure to pesticies and to other infections such as schistosomiasis and arbovirus (an RNA virus trans- mitted by insect vectors) remain to be elucidated

Profil du bilan biologique initial de l'enfant atteint du lymphome de Burkitt à Abidjan: cas du service de péediatrie du CHU de Treichville

L'OBJECTIF : de ce travail etait de repertorier les differentes perturbations du bilan biologique initial de l'enfant atteint du lymphome de Burkitt dans le but d'ameliorer la prise en charge; METHODOLOGIE: II s'agit d'une etude retrospective effectuee dans l'unite d' oncologie du service de pediatrie du CHU de Treichville portant sur 115 patients de 0 a 18 ans atteints du lymphome de Burkitt sur une periode de Sans 5mois (janvier 2000-juin 2005) et ayant un bilan biologique.RESULTATS :-Au Plan epidemiologique :*une moyenne de 21 cas/an enregistres portant sur des enfants d'age moyen de 7;64 ans avec une predominance masculine nette (sex-ratio = 2;19);*une predominance des cas dans les regions des lagunes (28;6pour cent); Sud-Bandama (10;7pour cent); igneby (9;8) et moyen Cavally (9;8pour cent);*un niveau social bas dans 71pour cent des cas ;*48;7pour cent des localisations tumorales etaient abdominales avec un delai de consultation long 1 a 3 mois dans 65;6pour cent.-Au Plan Clinique*66pour cent de patients etaient au stade III de Murphy avec;*dans 52;7pour cent des cas un poids inferieur a la normale pour leur age.-Au plan biologique; nous avons mis en evidence*Une anemie de type hypochrome microcytaire a ete retrouvee dans 81;4pour cent des cas avec 78pour cent de deces*Une elevation des transaminases et de la bilirubinemie*les taux eleves d'uree et de creatinine realisant un tableau d'insuffisance renale ont ete mortels dans 100pour cent des cas.*le syndrome de lyse tumorale realise par un taux d'acide urique eleve dans 36;4pour cent des cas; une hyperkaliemie (7;5pour cent des cas); une hypocalcemie (38;5pour centdes cas).*un taux de LDH eleve dans 72;4pour cent des cas.Ces elements sus cites pourraient etre consideres comme des facteurs de mauvais pronostic.- Au plan Therapeutique et Evolutif;70pour cent des patients ont ete traites avec pour resultats: 44;3pour cent de deces; 40pour cent de perdus de vue; 9;6pour cent de guerisons et 2;6pour cent de rechutes.CONCLUSION: L'anemie hypochrome microcytaire; la leucocytose; l'hyperuricemie; l'hyperlacticodeshydrogenase et perturbations du bilan ionique; renal et hepatique sont les principales anomalies biologiques rencontrees au cours de cette etude

Le lymphome de Burkitt avec localisation neuromeningee : caracteristiques epidemiologiques; cliniques et evolutives

L'etude epidemiologique; clinique et evolutive du Iymphome de Burkitt avec localisation neuromeningee sur une serie de 42 patients recenses dans le service d'hematologie clinique du CHU de Yopougon de Juin 1989 a Novembre 2002 a permis de faire les observations suivantesSUR LE PLAN EPIDEMIOLOGIQUE-la frequence : la localisation neuromeningee et medullaire du lymphome de Burkitt est peu frequente estimee a 19pour cent-l'age moyen etait estime a 7 annees-le sexe masculin est predominant avec une sex-ratio de 2;5-le niveau socio-economique : il a ete observe une nette predominance des sujets ayant un bas niveau socio-economiqueSUR LE PLAN CLINIQUE-les motifs de consultation sont domines par les tumeurs maxillo-faciales (26 pour cent) et les masses abdominales (24pour cent)-les signes physiques frequemment rencontres sont l'alteration de l'etat general (95 pour cent). l'anemie (88 pour cent). la fievre (69pour cent). le deficit moteur (55pour cent) et le syndrome meninge (38pour cent)-les atteintes neurologiques:l'atteinte meningee est dominante (43pour cent)-les formes cliniques associees:la localisation abdomino-pelvienne de la maladie de Burkitt est le plus souvent associee a la localisation neurologique dans 36pour cent des cas.SUR LE PLAN EVOLUTIF-le traitement:*le protocole CMA a ete le plus frequemment utilise pour traiter les patients de notre etude soit 49pour cent des cas.*la reponse au traitement : l'echec au traitement a ete le plus rencontre soit chez 64pour cent des patients.-le devenir des patients : seulement 5pour cent des patients ont ete declares gueris. 59pour cent en sont decedes

Malignancies in HIV-infected children at Siriraj Hospital.

BACKGROUND: Some malignancies such as Kaposi's sarcoma, non-Hodgkin's lymphoma (NHL) are one of the acquired immunodeficiency syndrome (AIDS)-defining illnesses. With the improving survival of patients with AIDS due to better prevention and treatment of infectious complications, there may well be an increase in AIDS-related malignancies. OBJECTIVE: To study malignancies in human immunodeficiency virus (HIV)-infected children in view of demographic data, HIV disease status, characters of malignancies, and treatment outcome. METHOD: Retrospective study was performed in HIV-infected children with malignancies at Siriraj Hospital from January 1995 to October 2001. RESULTS: During the 6 year and 10 month period, there were 7 HIV-infected children (2 boys, 5 girls) with malignancies. Mean age at diagnosis of malignancies was 3 years 7 months (2 years 6 months-5 years). Hepatomegaly and lymphadenopathy were the most common presenting symptoms. All patients had NHL stage III or IV. Burkitt's lymphoma was the predominant type. Six patients were treated with appropriate chemotherapy and one patient also received antiretroviral therapy. Only one patient with large cell lymphoma stage IV who received both antiretroviral and chemotherapy has survived to date. Five patients died during chemotherapy treatment and one patient died before receiving chemotherapy. Causes of death of these patients were infections. One of them with Burkitt's lymphoma stage III also had central nervous system (CNS) relapse at the time of death. Mean survival time after diagnosis with malignancies was 11 months (15 days-3 years 1 month). CONCLUSION: NHL is the most common malignancy in HIV-infected children at Siriraj Hospital. Age at presentation of NHL in these children is younger than their non-HIV counterpart. Outcome of treatment is poor. Adjustment protocol for treatment of malignancy in HIV-infected children combined with antiretroviral therapy for controlling HIV infection should be studied further.

Le lymphome de burkitt de l'adolescent et de l'adulte : aspects epidemiologique et clinique

L'etude epidemiologique et clinique du lymphome de Burkitt de l'adulte sur une serie de 40 patients recenses dans le service d'hematologie clinique du CHU de Yopougon de 1991 a 2000 a permis de faire les observations suivantes :Sur le plan epidemiologique :-la frequence : le lymphome de Burkitt chez l'adolescent et l'adulte est tres peu frequent; estime a 18;35 pour cent chacun-l'age moyen est estime a 23;03 annees-le sexe : la predominance du sexe masculin avec un sexe ratio de 1;5-le niveau socio-economique : la predominance des sujets de bas niveau socio-economique a ete constatee-Le domicile : la predominance classique en zone de foret est netteSur le plan clinique :-La symptomatologie fonctionnelle est tres variee mais dominee par l'amaigrissement (85 pour cent des cas); les douleurs abdominales (72;5 pour cent des cas).-Le delai de consultation : il est long; en moyenne de 110;55 jours soit 3 mois et 1O jours.-L'etat general altere dans 37;5 pour cent des cas contrairement aux donnees classiques.-Les localisations : l'atteinte abdomino-pelvienne est plus frequente 90 pour cent des cas.Les localisations ganglionnaires peripheriques viennent en deuxieme position.Est-ce une particularite chez l'adulte ? Ce d'autant plus que les formes ganglionnaires sont rares chez l'enfant.Les localisations neuro-meningees et medullaires sont peu frequentes.-Le delai de diagnostic : il est court; en moyenne 6 jours avec des extremes allant de 1 jour a 40 joursLa classification : les stades I et II sont absents. Le stade III predomine avec 90 pour cent des cas

Epidemiologia do linfoma de Burkitt no Brasil / Epidemiology of Burkitt's lymphoma in Brazil

Neste relato, são apresentados os aspectos epidemiológicos do linfoma de Burkitt, aspectos clínicos e os estudos relevantes sobre o tema, realizados no Brasil.

The epidemiological and clinical aspects and the relevant studies concerning Burkitt's lymphoma in Brazil are detailed in this paper.

Burkitt's lymphoma-a study of 50 consecutive cases

A retrospective study of Burkitt's lymphoma done over a period of 7 years is presented. The relative frequency of Burkitt's lymphoma as compared to other non-Hodgkin's lymphomas was 6.35%. Although Pakistan is non-endemic for Burkitt's lymphoma, but the frequency of the disease is higher than other non-endemic countries. There was male predominance [M: F 2.3:1]. Majority of the cases were in pediatric age group and 12% were older than 35 years. The main clinical presentation was abdominal [42%], either in the intestinal tract [22%] or retroperitoneal [18%] region [American mode of presentation]. Jaw tumour [4%] [African mode] was rare. Sporadic cases at almost all sites were also encountered. Burkitt's lymphoma presenting as primary nodal disease was seen in 36% cases. Fifty-four percent showed bone marrow infiltration. The stage of the disease at diagnosis was advance in 54% cases. Follow-up of ten cases revealed poor survival inspite of treatment

Massive chemotherapy and autologous bone marrow transplantation in Burkitt's lymphoma: the first two patients successfully treated in Thailand.

Massive chemotherapy and autologous bone marrow transplantation (ABMT) have been successfully used for the treatment of Burkitt's lymphoma. We report our first success with such treatment in two children with Burkitt's lymphoma in Thailand. Both patients had massive abdominal tumors with ascites and minimal bone marrow metastasis at the first presentation. They received induction chemotherapy and intensive treatment including central nervous system prophylaxis with cranial irradiation and intrathecal methotrexate until being in complete remission before starting massive chemotherapy, comprising the combination of BCNU, cytosine arabinoside, cyclophosphamide and 6-thioguanine followed by ABMT. Both patients recovered completely following intensive supportive treatments post ABMT and are still good health without evidence of the disease for 18 and 8 months after transplantation respectively. The role of massive chemotherapy and ABMT for the treatment of non-Hodgkin's lymphoma especially Burkitt's lymphoma was discussed.

El linfoma de Burkitt en Honduras / Burkitt lymphoma in Honduras

Se informan los primeros 37 casos de Linfoma de Burkitt en Honduras, los que fueron diagnosticados en un lapso de 6 años en el Hospital-Escuela de Tegucigalpa. Se expone su epidemiología, sus caracteres clínicos, su histopatología, serología, resultado del tratamiento y se efectúa una discusión final

Revisión de las características clínicas y epidemiológicas en las historias de 85 casos de linfoma de Burkitt / Review of clinical and epidemiological characteristics in the history of 85 Burkitt's lymphoma cases

Se describen características clínicas epidemiológicas del linfoma de Brukitt, de manera sistemática y ordenada mediante la revisión de casos reportados tanto nacionales como internacionales. Se comparan casos en cuanto a la clínica y epidemiología.

Burkitt's lymphoma in Thai children: an analysis of 25 cases.

Twenty five cases of Burkitt's lymphoma in Thai children were diagnosed at the Department of Pediatrics, Siriraj Hospital during the period of 13 years (January 1969 to April 1982). Males were more affected than females with the ratio of 1.7:1. The age ranged from 2 to 11 years with the median age of 4-5 years. The most common clinical manifestations were abdominal mass associated with nausea vomiting, abdominal pain, anorexia, weight loss and generalized lymphadenopathy which occurred in 50-60% of cases. Additional symptoms and signs included anemia, hepatosplenomegaly, edema and pleural effusion. Jaw tumor was found in only 37.5% of the patients. Definite diagnosis depended on the characteristic starry sky appearance of the lymph node biopsy or section of abdominal mass. In advance cases, the tumor cells could be discovered in bone marrow aspiration, ascitic fluid pleural fluid and cerebrospinal fluid. The typical blast cells were detected in the peripheral blood in 4 cases. Antibody to Epstein-Barr virus could be detected in almost all cases with high titers in some cases. Most patients responded very well to local irradiation and chemotherapy with prednisolone plus cyclophosphamide and vincristine or methotrexate. However, relapse occurred rapidly and 80% of the patients died within 3 months after diagnosis with the median survival of only 1 month. Five cases expired early before any specific treatment. The main causes of death were disease, sepsis, excessive bleeding and hyperkalemia.(ABSTRACT TRUNCATED AT 250 WORDS)

Non-Hodgkin's lymphoma in children

Non-hodgkin's Lymphoma is the commonest malignant tumor in children below 12 years of age in Libya. An Unusual pattern of predominant primary intestinal lymphoma was observed in 19 cases studied during the last 2 years. The clinical features are described and plan of management is discussed. A plea is made for multidisciplinary approach for better understanding of these tumors