Editor's Note: The "2024 Nanjing Lymphoma Forum" was held in Nanjing from May 11-12, 2024. The conference, primarily conducted through in-person exchanges, invited renowned experts in the field of lymphoid tumors from both domestic and international arenas. Through lectures, case discussions, and other forms of interaction, the forum focused on the latest achievements and advancements in the basic and clinical aspects of international lymphoid tumors. The goal was to further enhance the overall level of lymphoma diagnosis and treatment in China. At the conference, Professor Donglu Zhao from the Harbin Hematology and Oncology Research Institute gave a detailed presentation on the "CSCO Lymphoma Diagnosis and Treatment Guidelines — Interpretation of the Key Points of the Burkitt Lymphoma Guidelines." For a deeper understanding of this topic, "Oncology Frontier - Hematology Frontier" has compiled the content for readers' reference.Pre-treatment Assessment and Staging
Before treatment, a thorough assessment should be conducted, including levels I, II, and III recommendations covering routine examinations, laboratory tests, imaging studies, bone marrow examinations, and staging.
Staging
BL staging follows the 2014 Lugano modification of the staging system, which no longer provides specific data limits for large bulky disease but instead records the largest diameter of the largest lesion. Stage II patients with large bulky disease should be treated based on the pathology type and adverse prognostic factors. For example, patients with indolent lymphoma and bulky disease may follow a limited-stage treatment model, while those with aggressive lymphoma and bulky disease should follow a progressive-stage treatment model.
Treatment
For adult BL, the conventional rituximab + CHOP regimen (R-CHOP) is less effective. Currently, short-term, multi-drug, dose-intensified chemotherapy regimens combined with CNS treatment (pediatric acute lymphoblastic leukemia regimen) are used, achieving very good efficacy, with many patients achieving long-term survival, making cure possible. High-risk patients who achieve complete remission may participate in clinical trials for consolidation therapy. The role of radiotherapy in Burkitt lymphoma is limited.
The “CSCO Lymphoma Diagnosis and Treatment Guidelines” provide expert recommendations for BL treatment based on risk stratification. For low-risk BL patients, level I expert recommendations include the dose-adjusted EPOCH regimen (with intrathecal methotrexate) + rituximab (2A evidence), CODOX-M + rituximab (2A evidence), and the Hyper CVAD/MA regimen + rituximab (2A evidence). For high-risk patients, level I expert recommendations include the dose-adjusted EPOCH regimen (with intrathecal methotrexate) + rituximab (2A evidence), the alternating CODOX-M and IVAC regimens + rituximab (2A evidence), and the Hyper CVAD/MA regimen + rituximab (2A evidence).
