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7 standard-of-care settings across 3 lines and 3 biomarker subgroups. Rows come from the cancer page's standard of care; the grid places each on its line and subgroup.
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Burkitt lymphoma that relapses | Relapse is uncommon, occurs early and is difficult to treat; it is the reason the first regimen must be the right one. Options are a non-cross-resistant salvage regimen such as R-ICE or R-GDP followed by autologous or allogeneic transplant in those who respond, CD19 CAR-T, which has activity but is less well established here than in diffuse large B-cell lymphoma, and a clinical trial. Central nervous system involvement at relapse requires high-dose methotrexate or cytarabine with intrathecal therapy. Early and explicit discussion of what is realistic belongs in this conversation, alongside the offer of a trial. | The lymphoma regimen alphabet: R-CHOP, pola-R-CHP, DA-EPOCH-R, ABVD, BEACOPP and the restStem cell transplant in lymphoma: what it is still forAutologous stem cell transplant (high-dose therapy)Allogeneic stem cell transplantationCAR-T cell therapyAxicabtagene ciloleucelMethotrexateCytarabineEarly integrated palliative care | NCCN B-Cell Lymphomas; ESMO | 92 |
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| FRα | Relapsed or refractory | No standard; salvage chemotherapy with autologous or allogeneic transplant in responders, CD19 CAR-T and bispecific antibodies in trials. | 92 |
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Adults | Dose-adjusted EPOCH-R (lower toxicity, effective in older and HIV-positive patients) or CODOX-M/IVAC-R or hyper-CVAD-R; CNS prophylaxis in all. | NCCN · Category 2A | 84 | |
| All comers | Resource-limited settings | Cyclophosphamide-based or modified LMB regimens with intrathecal therapy, adding rituximab where available; investment in supportive care (transfusion, antimicrobials, tumour lysis management) is the main lever. | SIOP PODC adapted treatment guidelines | 80 | |
| All comers | Burkitt lymphoma in adults: which intensive regimen, and the pre-phase that prevents tumour lysis | The fastest-growing human tumour, with a doubling time measured in hours, and curable in the large majority when treated immediately with an intensive multi-agent regimen that includes central nervous system-directed treatment. R-CHOP is not adequate and should not be used. Three accepted regimens. Risk-adapted dose-adjusted EPOCH-R, tested in 113 adults across 22 centres: low-risk patients received three cycles with no central nervous system prophylaxis and high-risk patients six cycles with intrathecal prophylaxis; event-free survival was 84.5 per cent and overall survival 87.0 per cent at a median 58.7 months, with event-free survival of 100 per cent in the low-risk group and 82.1 per cent in the high-risk group. It worked equally well regardless of age, HIV status and IPI group, and five patients (4 per cent) died of treatment. CODOX-M/IVAC and hyper-CVAD with high-dose methotrexate and cytarabine are the older, more intensive inpatient alternatives, used particularly where there is central nervous system involvement, for which dose-adjusted EPOCH-R performed least well. Before the first full dose: a pre-phase of low-dose cyclophosphamide and prednisolone for about a week to shrink the tumour gradually, intravenous fluids, allopurinol or rasburicase, and electrolyte monitoring every six to eight hours. Tumour lysis syndrome, not the lymphoma, is what kills people in the first week. | Tumour lysis syndrome in lymphoma: who is at risk, and rasburicaseRasburicaseThe lymphoma regimen alphabet: R-CHOP, pola-R-CHP, DA-EPOCH-R, ABVD, BEACOPP and the restRituximabEtoposideDoxorubicinCyclophosphamideVincristinePrednisoneMethotrexateCytarabineIfosfamideIntrathecal therapy (lumbar puncture, Ommaya reservoir)Fertility before lymphoma treatment: what to ask for, and when | NCCN B-Cell Lymphomas; ESMO; risk-adapted DA-EPOCH-R (JCO 2020) | 84 |
| All comers | Burkitt lymphoma with HIV, and in countries where the endemic form is common | HIV does not change the regimen. In the 113-adult dose-adjusted EPOCH-R study a quarter of patients were HIV positive and did as well as the rest; antiretroviral therapy is continued through chemotherapy, with attention to interactions, and co-trimoxazole prophylaxis is given. Rituximab is used in HIV-associated Burkitt lymphoma provided the CD4 count is not very low. The endemic form, driven by Epstein-Barr virus and malaria and presenting as a jaw or abdominal mass in children in equatorial Africa, is treated with regimens designed for what a unit can actually deliver: reduced-intensity cyclophosphamide-based protocols with intrathecal therapy, given where blood products, dialysis and intensive care may not be available. Cure rates in those settings are lower than in high-income countries, and the limiting factors are late presentation, abandonment of treatment and supportive care rather than the drugs. Where rituximab can be obtained, adding it to chemotherapy improves outcomes in high-risk paediatric mature B-cell lymphoma. | Practical recommendations for the management of children with endemic Burkitt lymphoma (BL) in a resource limited settingRituximab for High-Risk, Mature B-Cell Non-Hodgkin's Lymphoma in ChildrenRituximab plus concurrent infusional EPOCH chemotherapy is highly effective in HIV-associated B-cell non-Hodgkin lymphomaRituximabCyclophosphamideIntrathecal therapy (lumbar puncture, Ommaya reservoir)Epstein-Barr virus (EBV) in cancerTumour lysis syndrome in lymphoma: who is at risk, and rasburicaseInfection prophylaxis in lymphoma: PJP, herpes, fungal risk and vaccination | NCI PDQ childhood non-Hodgkin lymphoma; Hesseling et al. for resource-limited settings | 84 |
| Age group | Children and adolescents, all stages | Risk-stratified LMB or BFM regimen with intrathecal therapy; rituximab added for high-risk (stage III with high LDH, stage IV, leukaemic) disease per Inter-B-NHL Ritux 2010; low-intensity pre-phase and tumour lysis prophylaxis. | Inter-B-NHL Ritux 2010 (NEJM 2020); NCI PDQ | 87 |
Lines and subgroups are parsed from the setting text of each standard-of-care row and can misclassify an unusual phrasing; the row’s own setting is always shown. Guideline chips reflect the NCCN category and ESMO-MCBS grade recorded on the cancer page, checked on its stated date. Not medical advice.