Freephone helpline 0808 808 5555 [email protected] www.lymphomas.org.uk Burkitt lymphoma Burkitt lymphoma is a cancer of the lymphatic system, a type of non-Hodgkin lymphoma. Even though more than 12,000 people are diagnosed with non-Hodgkin lymphoma in the UK every year, many people have never heard of it before. Even fewer people have heard of Burkitt lymphoma. This leaflet aims to answer the main questions that people diagnosed with Burkitt lymphoma or their relatives might ask: ● What is Burkitt lymphoma? What causes Burkitt lymphoma and who is affected by it? Figure 1: The lymphatic system ● What are the symptoms of Burkitt lymphoma? ● How is it diagnosed and what further tests might I need? ● ● What is meant by ‘the stage’? ● How is Burkitt lymphoma treated? What happens after my initial treatment? Neck (cervical) lymph nodes Lymph vessels Armpit (axillary) lymph nodes ● What is lymphoma? Groin (inguinal) lymph nodes Thymus Diaphragm (muscle that separates the chest from the abdomen) Spleen Liver Lymphoma is a cancer that develops when a type of white blood cell called a lymphocyte grows out of control. Lymphocytes usually fight infections and often collect in our lymph nodes (glands). These lymph nodes are part of our lymphatic system, which forms part of our immune system. Lymphatic tissue also occurs in other places such as our lungs and gut. In these areas, lymphocytes may be needed to fight infections that we breathe in or swallow with our food. Lymph nodes are found in many areas of our bodies: some are easily felt if they are enlarged; others are internal and may only be seen on scans. Our lymph nodes act like sieves in our lymphatic system, and lymphocytes often collect in them. If our bodies make more lymphocytes, for example to fight a sore throat, our nodes may swell until the infection has gone. Burkitt lymphoma LYM0126/BurkLymph/2012v2 1/12 In the same way, a build-up of cancerous lymphocytes can make lymph nodes swell. They may collect in other places too, such as the spleen, liver, gut, skin and bone marrow. When these organs are involved by lymphoma, they are called ‘extranodal sites’. There are many different types of non-Hodgkin lymphoma. These can be divided by the type of lymphocyte that has turned cancerous. So B-cell lymphomas arise in cells known as B lymphocytes; T-cell lymphomas in T lymphocytes. They can also be divided into high-grade (or fast-growing) lymphoma and low-grade (or slow-growing) lymphoma. What is Burkitt lymphoma? Burkitt lymphoma is named after a doctor called Denis Burkitt, who first wrote about this kind of tumour in children and young adults in Africa. The type of Burkitt lymphoma he described is called the ‘African-type’ (or ‘endemic’) Burkitt lymphoma. Another type of Burkitt lymphoma (the ‘sporadic’ type) is more often seen in the Western world and can affect anyone. This leaflet contains information mainly about the sporadic type. Burkitt lymphoma is quite rare: only 1 in every 30–50 people with a B-cell non-Hodgkin lymphoma will have this type of lymphoma. It is one of the fastest growing lymphomas, but this actually helps when it comes to treatment. It means that it can often be cured with intensive treatments. What causes Burkitt lymphoma? In some cases, Burkitt lymphoma is linked to previous infection with the Epstein–Barr virus (EBV), the virus that causes glandular fever. For the endemic type, this is almost always the case. EBV is a common virus: 9 out of 10 adults in the UK have evidence in their blood of previous infection. It is not clear why some people develop lymphoma whilst most do not. The virus seems to cause prolonged stimulation of some people’s normal B cells. This increases the chances of the cells becoming cancerous, but is not the whole story. Although this lymphoma is sometimes linked to a virus, it is important that you know: ● You cannot catch lymphoma. ● You did not inherit it from your parents. ● You cannot pass it on to others. Who is affected by Burkitt lymphoma? Burkitt lymphoma can affect both adults and children. It makes up over a third of all the lymphomas seen in children and is relatively common in adolescents and young adults. It is now also being recognised more often in those aged over 60. The endemic type of Burkitt lymphoma is typically seen in children, mainly in central Africa. Over two-thirds of the adults with Burkitt lymphoma are men. In children, boys are more likely to be affected than girls. People who have HIV/AIDS (human immunodeficiency virus/ acquired immune deficiency syndrome) are more likely to develop Burkitt lymphoma. This is probably because HIV, like EBV, may over-stimulate the B cells. Many patients with Burkitt lymphoma will not have HIV or Burkitt lymphoma LYM0126/BurkLymph/2012v2 2/12 AIDS. However, your doctors will almost certainly recommend you have a test to rule out HIV infection. This is because HIV is now very treatable and it is important that everyone with HIV and Burkitt lymphoma receives effective therapy for both conditions. The outcome for people with Burkitt lymphoma who also have HIV has improved rapidly in the last few years. What are the symptoms of Burkitt lymphoma? The symptoms of Burkitt lymphoma often come on over just a few weeks because the lymphoma cells are dividing so quickly. For the same reason, it is common for the lymphoma to be in several places by the time it is diagnosed. You will probably have swelling of one or more lymph nodes in different parts of your body. Many people with Burkitt lymphoma have lymphoma affecting their bowels. If your bowels are affected, you may have abdominal pain, sickness and/or diarrhoea. These symptoms may sometimes even be confused with appendicitis. The lymphoma might also cause a collection of fluid within your abdomen (called ‘ascites’) or might cause your bowel to become obstructed or bleed. Burkitt lymphoma is often found in extranodal sites, so you are likely to have other areas involved too. You may also have other symptoms of lymphoma, including night sweats, tiredness, flu-like symptoms and unexplained weight loss. Many people have Burkitt lymphoma in their bone marrow. The presence of lots of cancerous cells in the bone marrow can stop it making healthy blood cells. You may develop anaemia (due to a shortage of red blood cells). Anaemia causes shortness of breath, bone pain and fatigue. Or you may have thrombocytopenia (a shortage of platelets). Thrombocytopenia means you are more likely to bleed and that your body will be less able to stop any bleeding. The lymphoma cells can sometimes be found in the bloodstream too, which is similar to leukaemia. It is not unusual for Burkitt lymphoma to involve the brain and spinal cord. This is known as your central nervous system (CNS). If affected, your symptoms will vary: you may have no symptoms or you could have headache, seizures, confusion or inability to concentrate. Burkitt lymphoma may be found in other organs such as the spleen, liver, kidneys, ovaries and breasts. In children with the endemic type, Burkitt lymphoma often affects the jaw. It seems to grow in the areas where the permanent teeth are forming. This rarely happens in the sporadic (Western) type. How is Burkitt lymphoma diagnosed? Burkitt lymphoma is usually diagnosed by biopsy of an enlarged lymph node or another affected tissue. You may already have had your biopsy, as generally no one will be able to say for sure that you have Burkitt lymphoma until after this is done. The biopsy is examined by a team of laboratory specialists, including a specialist pathologist, using a variety of tests. Better and more advanced tests for this condition have been found in recent years and studies continue to work out the best ones to do. This is because it is very important to correctly identify Burkitt lymphoma. It needs to be treated differently from most high-grade lymphomas. Burkitt lymphoma LYM0126/BurkLymph/2012v2 3/12 The tests include looking at the cells under a microscope and looking for specific proteins on and within the cells and for changes within the cells’ genes. In Burkitt lymphoma, these tests will show that almost all of the cells are actively dividing. They will also show that one gene, known as myc, has changed position and is overworking. It is this that makes the cells divide so quickly. Some of these tests may take a while to complete so it may be a few weeks before your exact diagnosis is certain. If there is any doubt, you will probably be started on therapy for Burkitt lymphoma while the results are awaited as treatment should not be delayed. If it turns out that you have another type of high-grade lymphoma, your doctors will then make any changes that are needed to your treatment. What further tests may be performed? Other tests that might be done before you start treatment for your lymphoma may include: ● Blood tests - to check for anaemia or other low blood counts - to check the salts in your blood and how your kidneys and liver are working - for LDH (lactate dehydrogenase), which measures your lymphoma’s activity - for infections such as HIV and hepatitis, which can flare up with lymphoma treatments. ● ● Bone marrow test. This involves a sample taken through a needle inserted into a bone at the back of your pelvis (above your hip). The area is numbed with a local anaesthetic but you may still feel some discomfort. Scans, which may include: -Computed tomography (CT) scan, which uses X-rays to produce an image of your internal organs and lymph nodes. -Magnetic resonance imaging (MRI) scan, which may provide better images of certain parts of the body such as the brain and nerves. -Positron-emission tomography (PET) scan, which is a relatively new test, is proving to be useful. It will not be done for everyone with Burkitt lymphoma as it might not be available quickly enough or within your hospital. It is much more important to start treatment promptly. ● ● ● Lumbar puncture. This removes a small sample of the fluid that cushions your spinal cord and brain (known as ‘cerebrospinal fluid’). The sample is taken using a needle inserted between the spinal bones in your lower back after the skin has been numbed with a local anaesthetic (see Figure 2). Cardiac tests such as electrocardiogram (ECG), echocardiogram or MUGA scan. These tests may be done to assess how well your heart is working. 24-hour urine collection to assess how well your kidneys are working. Please contact our helpline if you would like further information about blood tests or scans. Burkitt lymphoma LYM0126/BurkLymph/2012v2 4/12 Figure 2: Lumbar puncture Staging of Burkitt lymphoma The ‘stage’ of your lymphoma shows which parts of your body have been affected. It is based on the examination by your doctor and the results of any tests you have had. The stage of your lymphoma will help the doctors to decide on the best treatment for you. Burkitt lymphoma may be classed as being ‘favourable’ or ‘unfavourable’. Do not be alarmed if you have ‘unfavourable’ disease, which is the case for most adults. The intensive treatments commonly used for Burkitt lymphoma are designed for this type of disease. Those with ‘favourable’ disease may need slightly less treatment. Most lymphomas, particularly in adults, are staged according to the following system, known as the ‘Ann Arbor system’. Stage I One group of lymph nodes affected Stage II Two or more groups of lymph nodes affected on one side of the diaphragm (see Figure 1) Stage III Lymph nodes affected on both sides of the diaphragm Stage IV Lymphoma is found either in organs outside the lymphatic system or in the bone marrow Using this system, your Burkitt lymphoma will be classed as favourable if three of the following apply to you: ● ● your LDH is normal your performance status is good (meaning you are up and about and able to carry out light work) ● your Ann Arbor stage is I or II ● your lymphoma is in no more than one extranodal site. Burkitt lymphoma LYM0126/BurkLymph/2012v2 5/12 Burkitt lymphoma is sometimes staged using the Murphy staging system instead, which is more often used for lymphomas in children. Stage I One group of lymph nodes or a single extranodal site affected, but not in the chest or abdomen Stage II Two or more groups of lymph nodes or two extranodal sites or one extranodal site and the nearby lymph nodes affected on one side of the diaphragm (see Figure 1) Or tumour in the bowel, whether or not the nearby nodes are affected Stage IIR The lymphoma was in the abdomen but has been completely removed by surgery Stage III Lymph nodes or extranodal sites affected on both sides of the diaphragm Or any tumours that started within the chest or alongside the spine Or large tumours that started within the abdomen Stage IIIA The lymphoma is in the abdomen only but cannot be removed by surgery Stage IIIB Three or more organs within the abdomen involved Stage IV Lymphoma in the bone marrow* or in the central nervous system * You will be regarded as having acute lymphoblastic leukaemia if more than a quarter of your bone marrow is replaced by lymphoma cells. But you will still receive the same treatment as other patients with Burkitt lymphoma. Using this staging system, your Burkitt lymphoma will be classed as favourable if it is stage I or IIR and your LDH is also normal. How is Burkitt lymphoma treated? Burkitt lymphoma is best treated with intensive chemotherapy, as long as your doctors think you are fit enough for this. Because of the type of chemotherapy needed and the fact that Burkitt lymphoma is uncommon, not all hospitals will offer this treatment. You may be transferred to a specialist centre where they are more used to treating this type of lymphoma. Being diagnosed with Burkitt lymphoma and told about the treatment you will need can be very frightening. It is important to bear in mind that Burkitt lymphoma generally responds very well to treatment. In fact, if you are able to complete all your treatment you have a very good chance of being cured. Do talk to someone if you find things difficult or scary, especially at the start. Your hospital team will understand how you feel and will want to do all they can to support you. You may already be in hospital when you are diagnosed because of your symptoms. If not, you will be admitted to hospital very quickly once the diagnosis has been made. This is because treatment for fast-growing Burkitt lymphoma needs to be started quickly before it can make you more unwell. Being an inpatient means any tests and procedures can be done promptly so that you are quickly ready to start your treatment. Burkitt lymphoma LYM0126/BurkLymph/2012v2 6/12 What is chemotherapy and how is it given? Chemotherapy means treatment with drugs or medicines. For Burkitt lymphoma, it involves giving a sequence of several different drugs that target the cancerous cells in different ways. The doses of the drugs used are high compared with those for many other types of lymphoma. This increases the chances of killing most of the lymphoma cells as quickly as possible. In addition, almost all patients with Burkitt lymphoma receive the antibody treatment rituximab (MabThera®) with their chemotherapy. Rituximab therapy is described in more detail on page 9. The chemotherapy typically used for Burkitt lymphoma is given intravenously (into a vein), usually as an infusion (a drip). Some of the drugs need to be given repeatedly for several days or are infused over a long period of time. Because of this, it can only be given to inpatients. In Burkitt lymphoma specific treatment is also needed to target the CNS (the brain and spinal cord). Some of the intravenous drugs do this, but usually drugs are given directly into the cerebrospinal fluid too. This is known as intrathecal chemotherapy (see page 8). As well as the infusions of drugs, you will need lots of fluids to keep your kidneys working well. You will probably receive the drug rasburicase (Fasturtec®) too. This new drug has made serious kidney problems much less common in people having chemotherapy for Burkitt lymphoma. You will also need to have regular blood tests to carefully monitor your kidneys, liver and blood cell counts. To make all this treatment easier, your doctors will probably recommend you have a tunnelled central line put in (see below) or you may be offered a PICC line (peripherally inserted central catheter) as an alternative (see page 8). It is likely your treatment will take several months and you should expect to spend days or even weeks at a time in hospital. If you are having intensive chemotherapy, you may get a number of different side effects (see page 8). There are lots of things that can be done to help prevent or relieve these. Do let people know how you are feeling and ask questions if you don’t know what is happening.Your hospital team will be there to support you through your treatment. What is a tunnelled central line? A central line is a soft plastic tube (or catheter) that is placed into a large vein near your heart. Fluids can go in through it and usually blood samples can be taken out without the need for repeated needles. A tunnelled central line is usually positioned on your upper chest with part of the line running through a tunnel under your skin. This reduces the risk of infection and allows the line to stay in for a longer time. You may hear these called a Hickman® or Groshong® line. The line is inserted during a small operation that usually requires a local anaesthetic. It will be held in place, at least at first, by a few small stitches and will be covered with a clear dressing. Hopefully it will stay in place for all of your treatment. When you go home, you will be given instructions about how to care for it. Despite this, central lines can become infected. You should contact your hospital immediately if you develop a temperature, feel shivery or if the area around the line becomes red or sore. Burkitt lymphoma LYM0126/BurkLymph/2012v2 7/12 What is a PICC line? A PICC line (peripherally inserted central catheter) is a soft plastic tube like a central line but it is put in through a vein in your arm at the level of your elbow. There is no tunnel so it may need to be replaced earlier, but it is generally easier to put in and take out. You should contact your hospital immediately if you develop a temperature, feel shivery or if the area around the line becomes red or sore. What is intrathecal chemotherapy? Chemotherapy that is injected directly into the cerebrospinal fluid (the fluid that bathes the spine and brain) is known as intrathecal chemotherapy. Only a few drugs can be given in this way (most often methotrexate and cytarabine). It is always given by a registrar or consultant during a lumbar puncture (see Figure 2) and a specialist chemotherapy nurse will also be present. Sometimes a device called an ‘Ommaya reservoir’ may be put in to avoid the need for lots of lumbar punctures. You may hear this treatment referred to as ‘CNS-directed therapy’ or ‘CNS prophylaxis’. Please contact our helpline if you would like further information about this type of treatment. What are the side effects of chemotherapy? The most common side effects of the kind of chemotherapy usually used for Burkitt lymphoma are: ● Low blood counts -Low white cell count (neutropenia): you will be much more prone to infections; your hospital team need to know at once if you have any signs of infection. -Low red cells (anaemia): you may be short of breath, or fatigued; a blood transfusion may help. -Low platelets (thrombocytopenia): you are more likely to bleed and your body will be less able to stop any bleeding; you may be given platelet transfusions to protect you or to help stop bleeding. ● Sore mouth (mucositis) or mouth ulcers: using mouthwashes regularly can help. ● Feeling sick or having diarrhoea: medication can often help. ● ● ● Hair loss: this is temporary; it typically begins within a couple of weeks and usually starts growing back a month or two after treatment has finished. Fatigue: this is very common; you may find it hard to concentrate or make decisions; you may even feel too tired to do simple things like watch TV or read. Damage to nerves (peripheral neuropathy): this commonly affects the nerves in your hands and feet; you might notice pins and needles, pain, numbness, clumsiness, problems with balance, increased sensitivity to heat or constipation. There are also a number of side effects that might affect you in the long term if your lymphoma is cured. These include reduced fertility and an increased risk of second cancers and heart disease. Your doctors will discuss with you what your risks are and what can be done to help. Burkitt lymphoma LYM0126/BurkLymph/2012v2 8/12 What other therapies might I also have? Rituximab (MabThera®) is now almost always added to chemotherapy for Burkitt lymphoma. It is a form of antibody therapy that targets CD20, a protein on the surface of B-lymphoma cells. It has been shown to improve success rates for treatment of many types of lymphoma. You may be asked to consider taking part in a trial to prove that it makes the treatment for Burkitt lymphoma work better too. Please contact our helpline if you would like more information about rituximab or clinical trials. Along with your chemotherapy you may be given a number of other drugs including: ● mesna and folinic acid, to protect your body from later drug effects ● anti-sickness medication (antiemetics) ● rasburicase (Fasturtec®) initially and allopurinol in later cycles, to protect your kidneys, particularly when many lymphoma cells are killed very quickly at the start of treatment ● prophylactic (preventive) antibiotics and antifungals, to reduce the risks of infection ● growth factors (G-CSF), to help your bone marrow recover quickly. Specific chemotherapy regimens One combination commonly used for adults in the UK is R-CODOX-M, which may be combined with R-IVAC. These initials refer to the names of the individual drugs. R-CODOX-M is rituximab, cyclophosphamide, vincristine (Oncovin®), doxorubicin and methotrexate. R-IVAC is rituximab, ifosfamide, etoposide (VP-16 or Vepesid®) and cytarabine (Ara-C). The doses of cyclophosphamide, ifosfamide, etoposide and cytarabine are each repeated on several days and the methotrexate takes a full day to give. Other treatments and lots of fluids are also needed to make sure the drugs do not stay in the body for longer than needed. R-CODOX-M on its own is used for people with Burkitt lymphoma that is considered ‘favourable’. Basically, this is early-stage Burkitt lymphoma that has not yet had a big impact on general health (see page 5). The R-CODOX-M cycle is usually repeated three times in all. For most people, with more advanced-stage Burkitt lymphoma, the combination R-CODOX-M and R-IVAC is used. Usually two cycles of R-CODOX-M are given, alternating with two cycles of R-IVAC. Another combination regimen that has been widely used for Burkitt lymphoma is R-hyper-CVAD. This consists of rituximab, frequent small doses of (hyperfractionated) cyclophosphamide, vincristine, doxorubicin (Adriamycin®) and dexamethasone. This combination is alternated with high-dose methotrexate and cytarabine. Typically four cycles of each will be given. In children and adolescents, several different combinations, which formed part of the LMB96 trial, are used. These include two cycles of COPADM, which consists of cyclophosphamide, vincristine (Oncovin®), prednisolone, doxorubicin (Adriamycin®) and methotrexate, along with intrathecal chemotherapy. Typically other chemotherapy regimens, such as CYVE (cytarabine and etoposide [Vepesid®]) or CYM (cytarabine and methotrexate) are used after the COPADM depending on how advanced the lymphoma is and how it responds to early treatment. Recently, trials in this age group have been focused on avoiding unnecessary treatment to reduce possible long-term side effects. Burkitt lymphoma LYM0126/BurkLymph/2012v2 9/12 What happens after initial treatment? Follow-up A few weeks after you complete your initial chemotherapy, your doctors will perform tests to check how well your lymphoma has responded. Hopefully you will be in a complete remission. This means that there are no signs left of your lymphoma. You will continue to see your specialist or another member of the hospital team regularly. This follow-up is to see how you are feeling, to monitor your recovery from treatment and to check there are no signs of the lymphoma coming back. People who have had Burkitt lymphoma will usually be followed up for several years after the end of their treatment. To start with, your appointments will be frequent, possibly once a month. This is because most problems will occur early on after treatment for Burkitt lymphoma. If your disease has not relapsed after 6 months, it is very likely your treatment has been successful, so your appointments will be spread out to every 6 months or more. If you are worried about your health at any time, you do not have to wait for your next appointment. You should contact your GP or hospital team to discuss your concerns. Further treatment If your lymphoma is not in complete remission after your initial treatment or if it comes back later (relapses), your doctors may offer you further treatment. What can be offered will depend on what treatment you have already had and how fit you are. You may be offered high-dose chemotherapy at this stage, which is different from the first treatment you will have received. This might also be followed by a stem cell transplant, which allows an even bigger dose of treatment to be given. Stem cells can be found in the blood and bone marrow and are the source of all blood cells. Stem cell transplants can be done using either your own cells (an autologous transplant) or another person’s cells (an allogeneic transplant). They are used to ‘rescue’ the bone marrow so it can produce new blood cells again after you have received treatment. These procedures can have a number of risks and will not be suitable for everyone. Your doctors and hospital team will discuss carefully with you any further treatment, so that you can decide what is best for you. Conclusion Burkitt lymphoma is a rare type of high-grade (fast-growing) B-cell non-Hodgkin lymphoma. It can affect both children and adults. The symptoms of Burkitt lymphoma usually come on quickly. They may include swelling of lymph nodes or other organs, night sweats, weight loss, abdominal pain, sickness, diarrhoea and shortness of breath. Burkitt lymphoma can often be cured with intensive chemotherapy. The treatment involves both intravenous and intrathecal therapy. Typically it will take several months to complete. You will probably have a tunnelled central line put in so that intravenous drugs and fluids can be given and blood tests taken. You may get a number of side effects during or after your Burkitt lymphoma LYM0126/BurkLymph/2012v2 10/12 treatment but you will be given treatments and support to help you cope with these. You will probably need to spend days or even weeks at a time in hospital. Your hospital team will explain what you should expect and will be there to support you through your treatment. Acknowledgement We are grateful to Dr Andrew McMillan for reviewing this article. Dr McMillan is a consultant haematologist at Nottingham City Hospital. Useful sources of further information about Burkitt lymphoma and chemotherapy Macmillan Cancer Support 89 Albert Embankment London SE1 7UQ 0808 808 00 00 (Monday–Friday, 9am–8pm) Order line for booklets 0800 500 800 via website www.macmillan.org.uk CancerHelp UK The patient information section of Cancer Research UK 0808 800 4040 (Monday–Friday, 9am–5pm) via website www.cancerresearchuk.org Selected references The full list of references is available on request. Please contact us via email (publications@ lymphomas.org.uk) or telephone 01296 619409 if you would like a copy. Swerdlow SH, et al (eds). WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues. 2008. IARC, Lyon. Linch DC. Burkitt lymphoma in adults. British Journal of Haematology, 2012. 156: 693–703. Miles RR, et al. Risk factors and treatment of childhood and adolescent Burkitt lymphoma/ leukaemia. British Journal of Haematology, 2012. 156: 730–743. Sandlund JT. Burkitt lymphoma: staging and response evaluation. British Journal of Haematology, 2012. 156: 761–765. Mohamedbhai SG, et al. Rituximab in combination with CODOX-M/IVAC: a retrospective analysis of 23 cases of non-HIV related B-cell non-Hodgkin lymphoma with proliferation index >95%. British Journal of Haematology, 2011. 152: 175–181. Mead GM, et al. A prospective clinicopathologic study of dose-modified CODOX-M/IVAC in patients with sporadic Burkitt lymphoma defined using cytogenetic and immunophenotypic criteria (MRC/NCRI LY10 trial). Blood, 2008. 112: 2248–2260. Patte C, et al. Results of the randomized international FAB/LMB96 trial for intermediate risk B-cell non-Hodgkin lymphoma in children and adolescents: it is possible to reduce treatment for the early responding patients. Blood, 2007. 109: 2273–2280. Burkitt lymphoma LYM0126/BurkLymph/2012v2 11/12 How we can help you We provide: ● a free helpline providing information and emotional support 0808 808 5555 (9am–6pm Mondays–Thursdays; 9am–5pm Fridays) or [email protected] ● free information sheets and booklets about lymphoma ● a website with forums and a chatroom – www.lymphomas.org.uk ● ● the opportunity to be put in touch with others affected by lymphoma through our buddy scheme a nationwide network of lymphoma support groups. How you can help us We continually strive to improve our information resources for people affected by lymphoma and we would be interested in any feedback you might have on this article. Please visit www.lymphomas.org.uk/feedback or email [email protected] if you have any comments. Alternatively please phone our helpline on 0808 808 5555. We make every effort to ensure that the information we provide is accurate but it should not be relied upon to reflect the current state of medical research, which is constantly changing. If you are concerned about your health, you should consult your doctor. The Lymphoma Association cannot accept liability for any loss or damage resulting from any inaccuracy in this information or third party information such as information on websites which we link to. Please see our website (www.lymphomas.org.uk) for more information about how we produce our information. © Lymphoma Association PO Box 386, Aylesbury, Bucks, HP20 2GA Registered charity no. 1068395 Produced 11.09.2012 Next revision due 11.09.2014 Burkitt lymphoma LYM0126/BurkLymph/2012v2 12/12
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