Burkitt’s Type Malignant Lymphoma – Small Non-Cleaved

Another names
Types
Causes
Symptoms
Diagnostic tests
Non-pharmacological treatments (therapies & other care)
Drug treatments
Dietary molecular supplements
Immune-booster / regenerative / stem-cell drugs
Surgeries
Preventions (realistic)
When to see a doctor (or go to the ER)
What to eat and what to avoid during intensive therapy
Frequently asked questions

Burkitt’s type malignant lymphoma – small non-cleaved (historically called “small non-cleaved” lymphoma; now classified as Burkitt lymphoma) is a very fast-growing cancer of B lymphocytes, which are white blood cells that help us fight infection. The tumor cells divide quickly. Under the microscope, doctors often see a classic “starry-sky” pattern, caused by many dividing tumor cells and many cleanup cells (macrophages). The disease grows so fast that it can double in size in a day or two. It often starts in the abdomen in many countries, and sometimes in the jaw or face in children from certain regions. It needs urgent diagnosis and rapid treatment because it can spread quickly to the blood, bone marrow, spinal fluid, and other organs. The modern name is Burkitt lymphoma; the older descriptive term “small non-cleaved” is now historical, but you may still see it in older papers and reports. SpringerOpen+2Cancer.gov+2

Burkitt lymphoma is a very fast-growing cancer of B-lymphocytes (a kind of white blood cell). The tumor cells divide quickly because the MYC gene is switched on, so the disease can double in size in days. Doctors now use the name Burkitt lymphoma instead of the older term “small non-cleaved.” There are three clinical forms: (1) endemic (common in parts of Africa, often linked to Epstein–Barr virus and malaria), (2) sporadic (seen worldwide, often in the abdomen), and (3) immunodeficiency-related (seen with HIV). Because it grows so fast, it needs urgent treatment with short, intensive blocks of combination chemotherapy, often with rituximab and CNS prophylaxis. Cancer.gov+2Cancer.gov+2

Another names

You may also see these names in records or older literature. They all point to the same basic disease group.

Burkitt lymphoma (BL). This is the current, preferred medical name. Cancer.gov
Malignant lymphoma, Burkitt type. Older pathology and registry reports used this wording. Wikipedia
Small non-cleaved cell lymphoma. This was a past morphologic term used before modern classifications. Medscape
FAB L3 acute lymphoblastic leukemia. When the bone marrow is heavily involved (traditionally >25% blasts), the same biology was once labeled FAB L3 ALL; today we classify these under Burkitt lymphoma/leukemia. Medscape

Types

Doctors group Burkitt lymphoma into three main subtypes. The tumor cells look the same; the differences are in geography, risk factors, and common tumor sites.

Endemic Burkitt lymphoma. Seen mainly in equatorial Africa and parts of Papua New Guinea. It often involves the jaw and facial bones in children. It is strongly linked with Epstein–Barr virus (EBV) infection and areas where malaria is common. Cancer.gov
Sporadic Burkitt lymphoma. Occurs worldwide, including North America, Europe, and Asia. It often starts in the abdomen (for example, bowel, appendix, mesentery) and can cause bowel pain, swelling, or blockage. SpringerOpen
Immunodeficiency-associated Burkitt lymphoma. Happens in people with weakened immune systems, such as those with untreated or advanced HIV infection, or after organ transplant with long-term immunosuppressive drugs. Pure Amsterdam UMC

In most cases, a gene called MYC (on chromosome 8) is moved next to antibody gene regions by a chromosomal swap called a translocation. The common one is t(8;14), and there are rarer ones t(2;8) and t(8;22). This change turns MYC “on” all the time, driving very fast cell growth. This is why the tumor grows so rapidly and why the microscope shows nearly 100% of cells in growth phase. These genetic changes are a hallmark of the disease and help doctors confirm the diagnosis in the lab. NCBI+1

Causes

Because a single “cause” is not always clear in human cancers, it is more accurate to list contributors and risk conditions proven or strongly linked to Burkitt lymphoma. Each item below is a brief, plain-English paragraph.

MYC translocation. The core biological driver is a MYC gene translocation, most commonly t(8;14). This genetic event makes the cell divide without control. It is necessary for the disease biology and is used diagnostically. NCBI
Epstein–Barr virus (EBV). EBV infection is present in most endemic cases and in a proportion of sporadic and HIV-related cases. EBV helps infected B cells survive and proliferate, increasing the chance that a MYC translocation will lead to lymphoma. Cancer.gov
Malaria as a co-factor. In endemic regions, chronic malaria weakens immune control of EBV-infected B cells. This chronic immune stimulation is thought to help BL arise in children. Cancer.gov
HIV infection. HIV lowers immune surveillance and allows abnormal B-cell clones to expand, increasing risk of immunodeficiency-associated BL. Pure Amsterdam UMC
Post-transplant immunosuppression. Long-term medicines that suppress the immune system after organ transplant can allow EBV-driven or MYC-altered B cells to expand. Pure Amsterdam UMC
Primary immune deficiency states. Rare inherited immune system problems can reduce control of EBV and abnormal B cells, raising BL risk. (Examples include certain antibody deficiencies.) Cancer.gov
Male sex. BL is more common in males than females in most series, suggesting biologic or exposure differences. Cancer.gov
Childhood age in endemic regions. In endemic BL, the peak age is early childhood, matching heavy EBV exposure and malaria burden. Cancer.gov
High EBV viral load or early EBV infection. Heavy or early-life EBV exposure may increase risk in certain settings by expanding susceptible B-cell pools. Cancer.gov
Geography (endemic zones). Living in equatorial Africa or similar settings with intense malaria transmission and near-universal EBV exposure raises risk for endemic BL. Cancer.gov
Chronic antigenic stimulation. Repeated immune activation (for example, from infections) can drive B-cell proliferation and the chance of MYC errors. This is a biologic model supported by endemic BL epidemiology. SpringerOpen
Genomic instability in germinal center B cells. Normal antibody diversification uses DNA breaks; rare mis-repairs can create MYC translocations. BL arises from these germinal center processes gone wrong. SpringerOpen
Co-infection patterns. In endemic zones, combined EBV and malaria exposure is a well-described combination that sets the stage for BL in children. Cancer.gov
Hepatitis or other chronic infections in immunodeficiency. In people with weakened immunity, multiple infections may contribute to B-cell dysregulation and BL risk. Pure Amsterdam UMC
Prior chemotherapy-related immune suppression. Less common, but profound or prolonged suppression could contribute to risk in select settings. (General principle in immunodeficiency-related lymphomas.) Pure Amsterdam UMC
Socio-environmental factors linked to infection burden. Crowding, sanitation, and exposure patterns influence EBV and malaria risk and thus endemic BL risk. Cancer.gov
Genetic susceptibility backgrounds. Population-level differences may influence how people respond to EBV and malaria and how B-cell mutations are handled. (Area of ongoing research.) SpringerOpen
High cell-turnover microenvironment. Tissues with active immune reactions can host rapidly dividing B cells where MYC errors occur. This is a mechanistic concept, not a single exposure. SpringerOpen
Prior EBV-driven proliferations. Conditions like chronic active EBV or EBV-positive post-transplant disorders can occasionally evolve into aggressive MYC-rearranged lymphomas. Pure Amsterdam UMC
Unknown/idiopathic factors. Many patients have no obvious risk factor; the disease can arise sporadically without a clear trigger beyond the MYC change. SpringerOpen

Symptoms

Symptoms depend on where the lymphoma starts and how fast it grows. Because the disease is fast, symptoms can appear and worsen over days to weeks.

Abdominal pain or swelling. Tumors in the bowel or mesentery can cause cramping, bloating, or a visible mass. Sometimes there is bowel blockage. SpringerOpen
Nausea and vomiting. Bowel involvement or blockage may trigger vomiting, sometimes with severe cramps. SpringerOpen
Changes in bowel habits. Diarrhea, constipation, or the sudden need to pass stool can happen with intestinal tumors. SpringerOpen
Jaw or facial swelling. In endemic BL, the jaw and facial bones are classic sites, especially in children. Teeth may loosen, or chewing may hurt. Cancer.gov
Rapidly growing lump. BL masses grow quickly anywhere they arise, including neck, abdomen, or groin. The speed is a warning sign. SpringerOpen
Fever. Fever can come from tumor inflammation or infection due to lowered immunity.
Night sweats. Soaking sweats at night can occur as part of “B symptoms” in aggressive lymphomas.
Unintended weight loss. Weight loss over a short time can happen with fast-growing cancers.
Fullness after small meals. An enlarged spleen or bulky abdominal mass can cause early satiety.
Jaundice or dark urine. If the liver or bile ducts are compressed or involved, yellowing of the eyes or dark urine can appear.
Testicular swelling. BL can involve the testes, causing painless enlargement.
Bone pain. If the marrow or bones are involved, aching or tenderness can occur.
Headache or vomiting from the head. Central nervous system spread can cause headaches, nausea, or behavior changes.
Weakness or numbness. If the spine or nerves are compressed, weakness, tingling, or numbness can develop quickly.
Infections or mouth sores. If the marrow is involved, blood counts can drop, leading to frequent infections or sores. (These symptom clusters are described across authoritative summaries.) Cancer.gov+1

Diagnostic tests

A) Physical examination (bedside assessment)

General inspection and vital signs. Doctors check fever, heart rate, blood pressure, and signs of dehydration or illness. Fast growth and fever can signal an aggressive lymphoma. Cancer.gov
Lymph node exam. Careful feeling of the neck, armpits, and groin can find enlarged, rubbery nodes that are new and growing fast.
Abdominal examination. Gentle pressing and tapping can detect masses, tenderness, enlarged liver or spleen, or signs of bowel blockage.
Orofacial and dental exam. In endemic BL, the jaw and facial bones are checked for swelling, loose teeth, or pain with chewing. Cancer.gov
Testicular exam. Painless testis enlargement can be a site of disease, especially in boys and men.
Neurologic screen. Doctors look for headache, vision change, weakness, or numbness suggesting brain, spine, or nerve involvement.

B) Manual tests

Palpation of masses and organ size. Repeated gentle palpation helps track how fast a lump is growing, which is important in BL.
Percussion for organ enlargement. Light tapping over the abdomen helps confirm liver and spleen enlargement.
Assessment of bowel sounds and guarding. Listening with a stethoscope and feeling for guarding helps detect obstruction or irritation from intestinal tumors.
Performance status scoring (ECOG). A quick bedside scale rates how illness affects daily activity; it guides urgency and intensity of treatment.
Pain mapping and tenderness checks. Careful, stepwise palpation helps localize painful areas from tumor pressure or blockage.
Bedside hydration and tumor lysis risk review. Even at the bedside, clinicians assess dehydration and risk of tumor lysis before procedures or therapy in such a fast-growing cancer. (These bedside practices are standard parts of aggressive lymphoma assessment.) Cancer.gov

C) Laboratory and pathological tests (the core of diagnosis)

Complete blood count (CBC) with differential. Looks for anemia, low platelets, or abnormal white cells. BL can spill into the blood or suppress marrow. Cancer.gov
LDH and uric acid. These rise with rapid cell turnover and help flag tumor lysis risk, common in BL due to its growth speed. SpringerOpen
Chemistry panel (kidney, liver, electrolytes). Baseline organ function guides safe imaging with contrast and safe chemotherapy dosing. Cancer.gov
HIV testing. All patients should be screened, because HIV changes management and raises risk of CNS involvement. Pure Amsterdam UMC
EBV testing (serology or PCR when relevant). EBV association is common in endemic and some immunodeficiency-related cases; it supports the clinical picture. Cancer.gov
Excisional biopsy of a node or mass. This is the gold standard. A whole piece of lymph node or mass is removed to allow full microscopic review and special studies. Cancer.gov
Flow cytometry immunophenotyping. This test labels cell markers to prove the cells are B-cells with a pattern typical for BL (for example, CD10 and BCL6, surface light-chain restriction), and usually negative for BCL2 and TdT. SpringerOpen
Cytogenetics/FISH for MYC rearrangement. Fluorescence in situ hybridization detects MYC breaks or specific translocations (t(8;14), t(2;8), t(8;22)), which confirm the biology of BL. Molecular tests may also define “double-hit” or “high-grade B-cell lymphoma” in differentials. NCBI
Bone marrow aspiration and biopsy. Checks for spread to the marrow; heavy marrow disease may be called Burkitt leukemia under older schemes. Medscape
Lumbar puncture with CSF cytology/flow. Because BL often reaches the central nervous system, spinal fluid is tested at diagnosis to guide treatment and prophylaxis. Cancer.gov

D) Electrodiagnostic tests (not routine for diagnosis, but sometimes useful)

Electrocardiogram (ECG). This checks baseline heart rhythm before starting certain chemotherapies and monitors if symptoms suggest heart strain; it does not diagnose BL itself.
Electroencephalogram (EEG). If seizures occur from brain involvement, an EEG can help assess electrical brain activity; again, this is supportive, not diagnostic of BL.
Nerve conduction studies/EMG (rare). If there is suspected nerve compression or plexus involvement from bulky disease, these can document nerve injury. (These tests are adjuncts in selected scenarios rather than standard BL diagnostics, which center on biopsy, flow, genetics, and imaging.) Cancer.gov

E) Imaging tests (to find, stage, and plan treatment)

Ultrasound of abdomen or testes. A quick, radiation-free way to detect masses, fluid, or testicular involvement and to guide biopsies. SpringerOpen
Contrast-enhanced CT (neck/chest/abdomen/pelvis). The main staging scan in many settings; shows size, number, and location of masses and organ involvement. SpringerOpen
PET-CT (FDG PET). Very active BL usually shows high uptake. PET-CT helps find all sites and assess response after therapy. SpringerOpen
MRI brain and spine (with contrast). Used when there are neurologic symptoms or positive spinal fluid; shows CNS or cord involvement. SpringerOpen
CT or MRI of jaws/face (endemic pattern). If the face or jaw is involved, local CT/MRI defines bone and soft-tissue disease to guide care. Cancer.gov

Non-pharmacological treatments (therapies & other care)

Urgent multidisciplinary care pathway — Starting care quickly in a specialist lymphoma center improves safety and outcomes because protocols are complex (chemo blocks, CNS prophylaxis, tumor-lysis prevention). Team care reduces delays and complications. Mechanism: coordination prevents under-dosing/over-dosing, missed intrathecal doses, and late management of metabolic emergencies. Medscape
Tumor lysis syndrome (TLS) prevention: fluids & monitoring — Before and during therapy, patients get vigorous IV hydration, strict input/output tracking, and frequent labs (K, phosphate, urate, creatinine). Purpose: avoid kidney failure and arrhythmias from rapid tumor breakdown. Mechanism: fluids dilute solutes and support kidneys while early labs trigger rescue steps. Cancer.gov
TLS urate control (allopurinol/rasburicase are drugs; the non-drug piece is hydration + early risk stratification) — Clinicians use risk tools and lab thresholds to decide if pharmacologic urate-lowering is needed; the non-drug element is the protocolized risk assessment and hydration. Purpose: prevent uric-acid nephropathy. Mechanism: proactive planning tied to tumor burden and LDH. Cancer.gov
Central line care & infection-control education — Teaching careful hand hygiene, line-care routines, fever action plans, and safe food handling reduces sepsis during neutropenia. Mechanism: reduces bacterial entry and speeds evaluation if fever occurs. CDC
Nutrition counseling during intensive chemo — Individualized plans keep calories and protein adequate, address taste changes, and prevent weight loss. Mechanism: preserves lean mass and treatment tolerance; modern guidance emphasizes safe-food practices over blanket “neutropenic” bans. ASCO Publications+1
Safe-food practices — Wash produce, cook meats/eggs thoroughly, prefer pasteurized dairy/juices, avoid buffets/raw sprouts; this reduces food-borne infections during neutropenia. Mechanism: lowers pathogen exposure while preserving diet quality. CDC+2Memorial Sloan Kettering Cancer Center+2
Fertility preservation counseling (pre-treatment) — Brief, urgent consultation about sperm banking or oocyte/embryo options before chemotherapy. Mechanism: protects future fertility from gonadotoxic agents (e.g., alkylators). Cancer.gov
Psychosocial support & anxiety management — Structured counseling and peer support improve adherence and help patients cope with urgent hospitalization and intensive regimens. Mechanism: reduces distress and supports decision-making. Cancer.gov
Physical activity as tolerated — Light aerobic and resistance exercise during and after chemo can improve fatigue and function; programs are adapted to counts and symptoms. Mechanism: counters deconditioning and supports cardiometabolic health. ASCO Publications
Vaccination planning — Non-live vaccines are timed around chemo; live vaccines are avoided. Household contacts should be up-to-date to reduce exposure. Mechanism: herd protection and optimal vaccine response timing. Cancer.gov
CNS surveillance logistics — The non-drug part is scheduling timely lumbar punctures, clear consent/explanations, and post-procedure recovery plans to keep CNS prophylaxis on schedule. Mechanism: reduces missed doses and complications. Cancer.gov
Rapid evaluation pathway for fever — “Fever = emergency” teaching ensures same-day assessment for any temperature ≥38°C during neutropenia. Mechanism: early cultures and empiric antibiotics reduce mortality. CDC
Oral care program — Soft brushing, saline/sodium-bicarbonate rinses, dental review before chemo lower mucositis/infection risk. Mechanism: reduces bacterial load and ulcer trauma. Cancer.gov
Bone health basics — Weight-bearing activity and calcium/vitamin D assessment help counter steroid-related bone loss during therapy. Mechanism: supports long-term skeletal health. ASCO Publications
Sleep and fatigue management — Structured sleep routines, light exposure, and pacing improve energy during cycles. Mechanism: stabilizes circadian rhythm and reduces fatigue burden. ASCO Publications
Smoking cessation & alcohol moderation — Reduces infection, cardiotoxicity risks, and supports healing. Mechanism: lowers oxidative stress and organ strain. Cancer.gov
Sun-safety and skin care — Gentle cleansing and moisturizers protect skin integrity during neutropenia and steroid use. Mechanism: intact skin = lower infection entry. CDC
Caregiver training — Teaching warning signs, safe food prep, and medication schedules improves adherence and early problem detection. Mechanism: prompt response to complications. CDC
Financial navigation & logistics — Early coordination for transportation, housing near centers, and insurance approvals prevents delays in cycle timing. Mechanism: maintains dose intensity and schedule. Medscape
Return-to-school/work planning — Stepwise reintegration protects recovery and reduces exposure risk during count nadirs. Mechanism: aligns activity with immune recovery. ASCO Publications

Drug treatments

⚠️ Doses/regimens vary by age, risk group, and protocol (e.g., R-CODOX-M/IVAC, BFM-based). Always follow your center’s protocol.

1) Rituximab (anti-CD20 mAb) — Class: targeted antibody. Use: added to pediatric-style intensive chemo in adults to improve outcomes. Typical dosing: 375–500 mg/m² IV on specified days of each block (protocol-dependent). Purpose: marks CD20-positive B cells for immune killing. Mechanism: antibody-dependent cellular cytotoxicity/complement lysis. Side effects: infusion reactions, HBV reactivation, PML risk. FDA Access Data+2FDA Access Data+2

2) Cyclophosphamide — Class: alkylator. Use: cornerstone in CODOX-M and many blocks. Dosing: varies by block; IV or PO per protocol. Purpose: kills rapidly dividing cells. Mechanism: DNA crosslinking → apoptosis. Side effects: myelosuppression, hemorrhagic cystitis (hydrate; mesna may be used), infections. FDA Access Data+2FDA Access Data+2

3) Doxorubicin (Adriamycin) — Class: anthracycline. Use: included in CODOX-M. Dosing: protocol-based mg/m² IV push/infusion; lifetime cumulative dose limits. Mechanism: intercalates DNA, inhibits topoisomerase II, generates free radicals. Side effects: cardiomyopathy (dose-related), myelosuppression, mucositis. FDA Access Data

4) Vincristine (and liposomal vincristine, Marqibo®) — Class: vinca alkaloid. Use: core cytotoxic in CODOX-M. Dosing: strict IV only; fatal if given intrathecally. Mechanism: blocks microtubules → mitosis arrest. Side effects: neuropathy, constipation. FDA Access Data+2FDA Access Data+2

5) High-dose Methotrexate (systemic) — Class: antifolate. Use: essential for CNS-penetrant therapy in BL. Dosing: high-dose IV with leucovorin rescue and drug-interaction monitoring. Mechanism: inhibits dihydrofolate reductase → blocks DNA synthesis. Side effects: mucositis, kidney injury (hydrate/alkalinize), hepatotoxicity, embryo-fetal toxicity. FDA Access Data+1

6) Intrathecal Methotrexate (CNS prophylaxis/therapy) — Class: antifolate via CSF route. Use: prevents/treats CNS disease. Dosing: small mg doses via lumbar puncture per schedule. Risks: neurotoxicity if mis-timed with systemic dosing; sterile technique required. Cancer.gov

7) Cytarabine (Ara-C, systemic) — Class: antimetabolite. Use: pillar of IVAC blocks (and other BL blocks). Dosing: high-dose IV per protocol with eye-drop prophylaxis. Mechanism: incorporates into DNA; inhibits DNA polymerase. Side effects: myelosuppression, cerebellar toxicity at high doses. FDA Access Data

8) Intrathecal Cytarabine / Liposomal Cytarabine (DepoCyt®) — Class: antimetabolite in CSF. Use: CNS prophylaxis/therapy. Risks: chemical arachnoiditis; given by specialists with steroid cover. FDA Access Data+1

9) Ifosfamide — Class: alkylator (IVAC). Dosing: multi-day infusions with mesna and hydration to protect bladder. Mechanism: DNA crosslinking. Side effects: myelosuppression, encephalopathy, hemorrhagic cystitis. FDA Access Data+1

10) Etoposide — Class: topoisomerase II inhibitor (IVAC). Mechanism: blocks DNA re-ligation → apoptosis. Side effects: myelosuppression; anaphylactoid reactions possible. Notes: given by experienced staff. FDA Access Data+1

11) Prednisone / Prednisolone — Class: corticosteroid. Use: cytoreduction and symptom control; part of some BL blocks. Mechanism: lympholytic and anti-inflammatory. Side effects: hyperglycemia, mood changes, infection risk, bone loss. FDA Access Data+1

12) Leucovorin (folinic acid) — Class: rescue agent. Use: protects healthy cells after high-dose methotrexate. Mechanism: bypasses DHFR block to replete reduced folates. Side effects: uncommon; dosing guided by MTX levels. FDA Access Data

13) Mesna (uro-protectant) — Class: thiol compound. Use: binds acrolein from oxazaphosphorines (ifosfamide) to prevent hemorrhagic cystitis. Mechanism: detoxifies in urine. Notes: part of IVAC supportive plan. FDA Access Data

14) Growth-factor support (G-CSF/filgrastim) — Class: hematopoietic growth factor. Use: shorten neutropenia after intensive blocks. Mechanism: stimulates neutrophil recovery; protocol-dependent. Risks: bone pain, rare splenic events. (General supportive standard in intensive regimens.) Cancer.gov

15) Antimicrobial prophylaxis (protocolized) — Class: antibiotics/antivirals/antifungals per counts and risk. Use: reduce febrile neutropenia and opportunistic infections. Mechanism: suppress pathogens during nadirs. (Center-specific.) Cancer.gov

16) IV fluids + electrolyte management (supportive) — Use: prevent AKI during TLS and high-dose MTX; correct K/Phos/Ca. Mechanism: renal protection and stability. Cancer.gov

17) Eye-drop prophylaxis with high-dose Ara-C — Class: steroid/vasoconstrictor drops (supportive). Use: prevent kerato-conjunctivitis. Mechanism: local anti-inflammatory effect. FDA Access Data

18) Proton-pump inhibitor caution with HD-MTX — *Not a “drug for BL,” but a safety rule: avoid interacting drugs that raise MTX levels. Mechanism: drug–drug interaction management. FDA Access Data

19) Protocolized antiemetics — Class: 5-HT3 antagonists/NK1 antagonists, etc. Use: prevent nausea/vomiting so patients can finish cycles. Mechanism: receptor blockade. (Standard of care.) Cancer.gov

20) Pain control plan — Class: step-wise analgesia. Use: improve comfort and function during therapy and procedures. Mechanism: multimodal analgesia. (Supportive standard.) Cancer.gov

Dietary molecular supplements

Vitamin D — Low vitamin D is common during cancer care; replacing a deficit may support bone and immune health. Typical dosing is individualized (often 800–2000 IU/day, or higher short courses if deficient). Mechanism: nuclear receptor effects on calcium/bone and immune modulation. Use only under clinician guidance to avoid hypercalcemia. ASCO Publications
Omega-3 fatty acids (EPA/DHA) — May help appetite and weight maintenance in some patients; typical combined doses 1–2 g/day with meals. Mechanism: membrane and eicosanoid effects that can modulate inflammation. Avoid high doses with thrombocytopenia without medical approval. ASCO Publications
Oral protein (whey or casein) — Shakes or powders can raise protein intake when appetite is low (e.g., 20–30 g per serving). Mechanism: supports lean mass and recovery. Choose pasteurized, reputable products. PMC
Probiotics (caution) — Some centers avoid live cultures during profound neutropenia because of rare bloodstream infections. Discuss first. Mechanism: microbiome modulation. If approved, use only quality-controlled products. Oncolink
Glutamine (for mucositis support, mixed data) — Sometimes used under supervision (e.g., 10 g 2–3×/day). Mechanism: fuel for enterocytes. Avoid unsupervised use; evidence is inconsistent. PMC
Selenium (nutrient repletion only) — If deficient, careful replacement within dietary allowance may be considered. Mechanism: antioxidant selenoproteins. High doses can be toxic—use only if prescribed. ASCO Publications
Zinc (for taste changes, deficiency) — Short, supervised courses may help taste in documented deficiency. Mechanism: cofactor in taste bud function. Excess can cause copper deficiency. ASCO Publications
B-complex (deficiency replacement) — Replace only if labs or diet suggest deficiency; avoid mega-doses. Mechanism: coenzymes for energy metabolism. ASCO Publications
Melatonin (sleep aid; discuss first) — Low-dose (e.g., 2–5 mg) may help sleep; interactions are possible. Mechanism: circadian signaling. ASCO Publications
Electrolyte supplementation (as directed) — Magnesium/potassium replacement is sometimes needed during intensive chemo; dosing is lab-guided. Mechanism: restores cellular function and prevents arrhythmias. Cancer.gov

Immune-booster / regenerative / stem-cell drugs

There are no over-the-counter “immune boosters” proven to treat Burkitt lymphoma. The items below are clinician-directed components of intensive care:

G-CSF (filgrastim/pegfilgrastim) — Dosing varies (daily filgrastim until ANC recovery or single-dose pegfilgrastim per cycle). Function: accelerates neutrophil recovery to shorten severe neutropenia. Mechanism: stimulates marrow myeloid lineage. Cancer.gov
IVIG (selected cases) — Dose individualized when severe hypogammaglobulinemia and recurrent infections occur. Function: passive antibody support. Mechanism: provides pooled IgG to improve opsonization. Cancer.gov
Erythropoiesis-stimulating agents (selected situations) — Given sparingly for chemo-induced anemia per guidelines. Function: reduce transfusion need. Mechanism: stimulates erythroid progenitors. Cancer.gov
Autologous stem-cell rescue (relapsed/refractory settings) — After salvage chemo, patients may receive high-dose therapy with autologous stem-cell support. Function: allows delivery of myeloablative doses. Mechanism: reinfuses collected stem cells to re-establish marrow. Cancer.gov
Allogeneic stem-cell transplant (select R/R cases) — Function: potential graft-versus-lymphoma effect. Mechanism: donor immune system targets malignant B cells. (Specialist decision.) Cancer.gov
Mesna with ifosfamide (supportive, protects bladder) — Dose tied to ifosfamide schedule. Function: prevents hemorrhagic cystitis. Mechanism: binds urotoxic metabolites in urine. FDA Access Data

Surgeries

Diagnostic/excisional biopsy — Purpose: get enough tissue for exact diagnosis (including MYC testing) before urgent chemo. Why: correct classification is essential; surgery is not curative in BL. MDPI
Laparotomy/laparoscopy for intussusception — BL can present with bowel telescoping (intussusception), especially in children. Surgery reduces the obstruction and removes the lead-point mass; then chemo starts promptly. PMC+2PubMed+2
Emergency surgery for perforation/obstruction — Rarely, BL causes perforation or complete blockage; resection or repair prevents sepsis and allows safe chemotherapy. PMC
Ports/central lines — For reliable delivery of complex regimens and frequent blood draws. Not disease-curing, but essential for safe care. Cancer.gov
Decompression/other procedures (case-by-case) — Very uncommon; performed only to treat life-threatening complications while definitive chemo continues. MDPI

Preventions (realistic)

HIV testing and treatment — Managing HIV lowers risk for immunodeficiency-related BL and improves tolerance of therapy. NCBI
Malaria control and EBV exposure reduction in endemic regions — Part of public-health prevention for endemic BL. NCBI
Prompt care for swollen jaw/abdominal masses/rapidly growing lumps — Early evaluation accelerates diagnosis. Cancer.gov
Vaccinations for household contacts — Reduces infection exposure during chemo. Cancer.gov
Safe-food hygiene during treatment — Lowers food-borne infection risk. CDC
Hand hygiene & sick-contact avoidance — Core infection prevention in neutropenia. CDC
Dental checks before chemo — Address infection sources. Cancer.gov
Fertility counseling pre-chemo — Prevents regret; allows banking options. Cancer.gov
Medication review (MTX interactions) — Prevents toxicity and delays. FDA Access Data
Care at expert centers — Complex regimens benefit from experienced teams. Medscape

When to see a doctor (or go to the ER)

Fever ≥38°C during or after chemo (medical emergency in neutropenia). Go immediately. CDC
Rapidly growing lump, jaw swelling, abdominal pain or fullness, night sweats, weight loss, or bowel changes. Seek evaluation quickly—BL grows fast. Cancer.gov
Severe vomiting, confusion, muscle cramps, reduced urine—possible tumor lysis or dehydration; urgent care needed. Cancer.gov
Severe headache, neck stiffness, weakness, or seizures—possible CNS involvement; urgent assessment. Cancer.gov

What to eat and what to avoid during intensive therapy

(Plain, practical, infection-safe tips—always follow your team’s advice.)

Eat more of these:

Cooked lean proteins (chicken, fish, eggs cooked firm) for protein recovery. CDC
Pasteurized dairy/yogurt if cleared by your team; helpful calories and protein. CDC
Well-washed and cooked vegetables (steamed, roasted, soups) for nutrients. CDC
Peeled fruits or canned fruit in juice if mouth sores limit chewing. CDC
Whole-grain breads, oatmeal, rice for steady energy. ASCO Publications
Nut butters from sealed jars (not bulk bins) if approved; easy calories. CDC
Plenty of safe fluids: boiled/bottled water, pasteurized juices, broths. CDC
Small frequent meals or shakes to meet protein targets. PMC
Season softly (herbs, mild sauces) to help taste changes. PMC
If advised, vitamin D and calcium in food/supplements for bone health. ASCO Publications

Avoid or be very careful with:

Raw/undercooked meat, fish, eggs (e.g., sushi, runny yolks). CDC
Unpasteurized milk/cheese/juice or soft-serve machines. CDC
Raw sprouts (alfalfa, bean, etc.). CDC
Salad bars, buffets, bulk bins (cross-contamination risk). Memorial Sloan Kettering Cancer Center
Deli meats unless reheated steaming hot. Memorial Sloan Kettering Cancer Center
Unwashed produce; always wash well (or peel). CDC
Alcohol excess (interactions, dehydration). Cancer.gov
Herbal blends/supplements without team approval (drug interactions). FDA Access Data
High-dose antioxidants without supervision (may interact with chemo). FDA Access Data
Grapefruit with certain drugs (check interactions). FDA Access Data

Frequently asked questions

1) Is “small non-cleaved” lymphoma the same as Burkitt?
Yes. The older “malignant small non-cleaved” term has been replaced by Burkitt lymphoma in modern classifications. Annals of Oncology

2) Why is treatment so urgent?
Because tumors can double in size in days. Starting protocol-based therapy quickly prevents organ damage and medical emergencies like tumor lysis. Cancer.gov

3) What regimens are common?
Adult centers often use R-CODOX-M/IVAC or similar pediatric-style blocks, with rituximab and CNS prophylaxis; pediatric/BFM-like protocols are used in younger patients. nssg.oxford-haematology.org.uk+1

4) Do I always need intrathecal (spinal) therapy?
Most protocols include it for prevention/treatment of CNS spread because BL often involves the CNS. Cancer.gov

5) What is tumor lysis syndrome?
A dangerous surge of potassium, phosphate, and uric acid when many cancer cells die at once; hydration, labs, and sometimes rasburicase/allopurinol control it. Cancer.gov

6) Are there operations that cure BL?
No—chemotherapy cures BL. Surgery is mainly for diagnosis or emergencies like intussusception or perforation. MDPI+1

7) What is rituximab’s role and risk?
It targets CD20 on BL cells and improves outcomes with chemo, but can cause infusion reactions, HBV reactivation, and rarely PML—patients are screened and monitored. FDA Access Data+1

8) Why so many supportive steps (lines, labs, eye drops, rescue meds)?
Intensive blocks deliver cure-level doses but require guarding the heart, kidneys, bladder, eyes, and marrow—protocols bundle these protections. FDA Access Data+1

9) Can I eat fresh fruits/vegetables?
Use safe-food practices (wash well; peel or cook) rather than eliminating all produce; blanket “neutropenic diets” that ban raw produce are not routinely recommended today. Follow your center’s advice. ASCO Publications+1

10) How soon will hair regrow and energy return?
Hair generally regrows within months; exercise and nutrition help recovery, but timing varies. ASCO Publications

11) What follow-up scans and tests are used?
PET/CT and blood tests are used to assess response and remission per protocol and clinical judgment. Cancer.gov

12) Will I be able to have children later?
Potentially—speak quickly about fertility preservation before treatment; risk depends on regimen and age. Cancer.gov

13) Are there long-term risks from therapy?
Possible heart effects (anthracyclines), neuropathy (vincristine), second cancers (rare), and fertility effects; survivorship care monitors these. FDA Access Data

14) What if the lymphoma comes back?
Specialists consider salvage chemo and, in selected cases, stem-cell transplant; clinical trials may be options. Cancer.gov

15) Where should I be treated?
At centers with Burkitt expertise because regimens and supportive care are highly specialized. Medscape

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