Calcifications in untreated Burkitt's lymphoma of the upper jaw

BACKGROUND: Dystrophic calcifications are uncommon in lymphomas. They may occur after chemotherapy or radiotherapy, whereas calcifications in untreated non- Hodgkin's lymphomas are rarely reported in the literature. CASE REPORT: We report the case of a 9-year-old boy who developed tumefaction of the right upper jaw. CT examination revealed a neoplastic lesion in the right upper jaw sinus with destruction of the maxilla and subcutaneous fat infiltration. Furthermore the tumor showed accentuated central calcifications. Histological examination revealed endemic type of Burkitt's lymphoma of the paranasal sinus. CONCLUSION: Our experience showed that calcification can rarely occur also in untreated Burkitt's lymphoma.     

Intensive chemotherapy in patients with generalized Burkitt's lymphoma

The results of a clinical trial in patients with generalized Burkitt's lymphoma using either multiple doses of cyclophosphamide or a cyclic, sequential regimen employing cylophosphamide, vincristine, methotrexate, and cytosine arabinoside (TRIKE) are reported. Of 42 evaluable patients 24 received cyclophosphamide and 18 received TRIKE. No significant differences were encountered between either group with respect to remission induction, relapse rate or survival. Remission duration was significantly prolonged in the patients receiving cyclophosphamide, but this event has little effect on survival. Although intensive chemotherapy is probably necessary in patients with generalized Burkitt's lymphoma, other variables such as meningeal involvement and immunologic factors appear to affect relapse and survival.     

Epstein-Barr virus-associated and other antiviral antibodies during intense BCG administration to patients with Burkitt's lymphoma in remission.

Patients with Burkitt's lymphoma in chemotherapy-induced remission received through dermal scarifications one or two doses per week of approximately 3 X 10(8) living BCG organisms (Pasteur Institute vaccine). This treatment was always followed by usually rapid increases by 1--4 log2 steps in the antibody titers to Epstein-Barr virus (EBV)-associated cell membrane antigens. Titer increases of less than 2.5 log2 steps within the first month after the start of BCG treatment correlated with a significantly elevated frequency of extradural relapse as compared to that seen in patients with larger titer rises. During this time, antibodies to EBV-associated viral capsid antigens and early antigens of D and R specificity, as well as antibodies against herpes simplex, varicella, cytomegalovirus, measles, and respiratory syncytial virus antigens, did not show any consistent or impressive changes.     

Non-Hodgkin's lymphoma protocols in the treatment of patients with Burkitt's lymphoma and lymphoblastic lymphoma: a report on 58 patients

Lymphoblastic lymphoma (LBL) and Burkitt's lymphoma belong to the very aggressive lymphomas requiring intensive therapy. We retrospectively analyzed 29 patients with Burkitt's lymphoma and 29 patients with LBL who received induction therapy with a CHOP-like lymphoma protocol. Patients with Burkitt's lymphoma (with a median age of 54.5 years) have a CR rate of 72% and a lymphoma free long-time survival of 55%. The International Prognostic Index was the most valuable prognostic factor for survival. Patients with LBL with a median age of 45 years had a CR rate of 55% and a lymphoma-free survival of 38%. Stage was the most predictive prognostic factor. Our data suggest that for older patients (>50) treatment with lymphoma protocols may yield response rates that are comparable to the results of patients with disseminated diffuse large cell lymphoma. Younger patients with risk factors should be treated with more intensive therapy like ALL-protocols. The role of auto-transplantation after high dose therapy (HDT) however as part of primary treatment still needs to be evaluated in clinical trials. One of four patients with LBL who received HDT and one of four patients with Burkitt's lymphoma who received HDT achieved long-term remission.     

Prolonged complete remission following high dose chemotherapy of Burkitt's lymphoma in relapse

Fourteen patients with American Burkitt's lymphoma resistant to conventional chemotherapy were treated with high-dose combination chemotherapy and intensive supportive care. Four patients died shortly after chemotherapy, 3 of an acute carditis. All ten remaining patients demonstrated tumor regression and 3 remain in prolonged complete unmaintained remission 29+, 19+, and 9+ months after treatment. These findings demonstrate that high-dose chemotherapy will benefit some patients with Burkitt's lymphoma unresponsive to conventional chemotherapy, but the medullary and extramedullary toxicity of this treatment strategy remains a formidable obstacle.     

Survival of Burkitt's lymphoma patients in Ghana

Of 141 suspected cases of Burkitt''s lymphoma referred from all over Ghana between November 1965 and June 30, 1969, the diagnosis of Burkitt''s lymphoma was confirmed histologically in 60. This report deals with survival of all 50 treated and evaluable cases. The overall estimated long term survival rate was 38·5% calculated actuarially. It was 63·2% for Stage I (10 of 18); 20·0% for Stage II (2 of 10); and 25·4% for Stages III and IV combined (3 of 22), thus confirming the value of staging as a rough guide to prognosis. Six Stage I patients who died all had large tumors. These results have been compared with a similar study by Morrow et al. (1967) from Uganda.     

Allogeneic bone marrow transplantation in adults with Burkitt's lymphoma or acute lymphoblastic leukemia in first complete remission

The prognosis of adults with Burkitt's lymphoma is very poor and depends on initial CNS and/or bone marrow involvement. We report results in nine adult patients with CNS (n = 9) and/or bone marrow involvement (n = 7) treated in first complete remission (CR) with allogeneic bone marrow transplantation (BMT). CNS treatment before the conditioning regimen consisted of cranial irradiation at 15 Gy (n = 8) and intrathecal chemotherapy (n = 9). The conditioning regimen included cyclophosphamide and total body irradiation (TBI) in a single dose. No postgraft CNS prophylaxis was administered. At the present time, seven patients are alive and disease-free at 18, 23, 44, 47, 54, 54, and 59 months. Two patients died at 14 and 7 months from transfusion-related acquired immune deficiency syndrome and bacterial septicemia and were disease-free at the time of their death. These preliminary results should encourage the use of BMT. A prospective randomized trial is warranted to further specify and investigate the advantages of allogeneic BMT versus conventional chemotherapy.     

Graft versus Burkitt's lymphoma effect after allogeneic marrow transplantation

While modern intensive chemotherapy protocols cure the majority of patients with Burkitt's lymphoma, the prospects of cure with salvage chemotherapy for relapsed or refractory disease are minimal. There are limited data on the results of allografting for well characterised Burkitt's lymphoma and in particular little on the impact of GVHD on transplant outcome. We report a patient with t(8;22) Burkitt's lymphoma who underwent an HLA-identical sibling allograft in second complete remission. Relapse occurred at day 60 post-transplant, without pre-existing GVHD. GVHD subsequently developed after withdrawal of immunosuppression and administration of alpha-interferon. Concomitantly the lymphoma regressed, consistent with a graft versus Burkitt's effect, until progression at day 200. A delayed, partial and transient response subsequently occurred to rituximab, a chimeric monoclonal antibody against the CD20 antigen. These observations suggest that immunotherapeutic approaches should be considered for Burkitt's lymphoma unable to be cured by conventional chemotherapy.     

Surface immunoglobulins on Burkitt's lymphoma biopsy cells from 91 patients

One hundred and fourteen biopsies from 91 cases of African Burkitt's lymphoma were examined by immunofluorescence methods for the presence of surface-associated mu, gamma, delta, kappa and lambda chains, as well as for the Fc region of gamma chains and for beta1C. Only 5% of the biopsies were surface-Ig-negative; 18% were negative for mu chains and 61% for gamma chains. Delta chain staining was absent, or borderline in a few tumors. Mu chains, gamma chains in a few highly reactive tumors and, in many cases, the predominant light chain seemed to be clonal markers. They gave no convincing evidence of more than one cell clone, either within single tumors or within syn- or metachronous tumors in one individual. Gamma chains in moderately stained tumors, Fc and beta1C correlated with each other and the first two reactivities decreased after incubation at low pH, indicating that their presence resulted from outside coating of the cells. The results indicated that one clone of B cells is involved in Burkitt's lymphoma in the large majority of cases. This clone is in a state of differentiation at which surface delta chains are not expressed. No prognostic information resulted from the analysis of the markers studied.     

Epstein-Barr virus-specific antibody-dependent cellular cytotoxicity in patients with Burkitt's lymphoma.

Coded sera from 54 patients with African Burkitt's lymphoma (BL) were titrated for antibodies against an Epstein-Barr virus (EBV)-induced membrane antigen in the antibody-dependent cellular cytotoxicity (ADCC) assay. The titers were then correlated with the progression of lymphoma growth following chemotherapy. In 74% of the patients with high ADCC titers (greater than 3,840), lymphomas showed partial or complete regression following therapy. In the medium-titered group (240-3,840), 36% of the lymphomas showed some response to therapy, while only 29% of the lymphomas in the low group (less than 240) responded to treatment. These preliminary results indicated that, as previously reported for patients with nasopharyngeal carcinoma, ADCC titers may be a prognotic value in patients with this EBV-associated disease. In an attempt to determine the identity of the ADCC antigen, some of these sera were examined for antibody to the four major MA components so far identified in the membrane of EBV-infected Raji cells. Sera with high ADCC titers in general contained antibody to the four major MA components, while low-titered sera usually contained antibody to three or less of these proteins. There were exceptions to this pattern, however, indicating that the ADCC antigen might differ from the four EBV-induced membrane components so far identified.     

Frequent association of Epstein-Barr virus in Japanese patients with Burkitt's lymphoma.

Seven Japanese patients with Burkitt's lymphoma (BL), residing in Hokkaido, were studied during the period, 1979-1991. Immunological analyses of their lymphoma cells showed all to express surface and/or cytoplasmic immunoglobulins. Chromosomal analysis was performed in five cases. Four of the five lymphomas had the chromosomal translocation, t(8;14), and one had t(2;8). Three patients had extremely high IgG antibody titers to Epstein-Barr virus (EBV) viral capsid antigen (VCA) and to EBV early antigens (EA). Two patients had positive antibodies to EA, and two others had normal antibody patterns comparable to those of EBV-seropositive age- and sex-matched healthy controls. Four of the seven lymphomas (57.1%) were positive for EBV-determined nuclear antigen (EBNA) by anticomplement immunofluorescence and/or EBV DNA using DNA-DNA reassociation kinetics, and/or Southern blot analysis. The frequency of EBV positivity in BL patients residing in Hokkaido was higher than that of cases previously reported in Japan. Three of the four EBV genome-positive BL patients responded well to chemotherapy, radiotherapy and/or surgical treatment, with no significant relapse being observed during the study period. In contrast, EBV genome-negative patients had poor prognoses despite having similar levels of clinical staging at the time of diagnosis.     

Concanavalin A receptors on the surface membrane of lymphocytes from patients with African Burkitt's lymphoma and lymphoma cell lines.

Lymphocytes isolated from the peripheral blood and from tumor tissues of patients with African Burkitt's lymphoma have been studied for cap formation and agglutinability by Concanavalin A (Con A). Peripheral blood from healthy adult persons served as a normal control and blood from patients with carcinoma served as a non-lymphoma control. These studies included 29 patients with Burkitt's lymphoma, 93 with carcinoma, and 105 healthy adult persons, as well as tumor tissues from 13 patients with Burkitt's lymphoma. The great majority of the carcinomas were from the face and neck regions. Lymphocytes from the blood of the majority of patients with Burkitt's lymphoma, as well as those from tumor tissues, exhibited a reduced cap-forming ability (2-6%) and increased Con-A-induced agglutinability compared to lymphocytes from healthy normal donors and from patients with carcinoma, although some of the lymphocytes from patients with carcinoma had a somewhat lower range of cap formation than the lymphocytes from healthy donors. No difference was observed in the interaction with Con A of lymphocytes from the different types of carcinoma studied. Eight lymphoid cell lines were established in our laboratory from the tumor tissues of patients with Burkitt's lymphoma. The cap-forming ability and agglutinability by Con A of these lines was examined and compared to those of the "classical" lymphoma lines: Raji, Daudi and P3HR1. All cell lines exhibited an increased Con-A-induced agglutinability and a reduced cap-forming ability compared to normal lymphocytes, except for P3HR1 cells which exhibited a cap-forming ability of 15-20%. These findings are discussed in relation to the association of the lymphocytes with malignancy and as a possible aid in the differential diagnosis between malignant lymphomas and other diseases.     

Proximal tubulare dysfunction associated with Burkitt's lymphoma

Generalized aminoaciduria, uricosuria, glycosuria and phosphaturia were discovered in a patient with advanced Burkitt's lymphoma with renal infiltration. The literature is reviewed and three pathogenetic mechanisms are discussed. It is presumed that proximal tubular dysfunction in this case was related to the marked peritubular infiltrate causing cell mediated immunological injury or direct tubular destruction by tumor.     

Burkitt's lymphoma in the Middle East

The clinical features of 30 retrospectively diagnosed cases of Burkitt's lymphoma (BL) at the American University Medical Center (AUMC) in Beirut differed from those of African Burkitt's in that the majority of the AUMC patients presented with abdominal disease, and from the American form, in that the AUMC patients were younger, with a median age similar to that of African BL patients.