About Burkitt's Lymphoma (BL)
Burkitt's Lymphoma is a very rare form of cancer with about only 300 new cases a year in the United States. It is one type of a group of malignant diseases know as the Non-Hodgkin's Lymphomas (NHL). These lymphomas are very similar to leukemias. As with other cancers, the exact cause of BL is not known. It grows very rapidly and a person who appeared in good health a month or 6 weeks ago may now be critically ill. BL is metastatic by nature, has a tendency to hide out in tricky places such as the central nervous system and may be cured with chemotherapy and/or bone marrow transplant. If you look it up on the internet you may find information that is not particularly helpful because there are three types of Burkitt's, the most common of which is African or Tropical. Noah does not have those types. His is a "sporadic" form.
Noah noticed a swelling under his arm this summer and asked the doctor he was working with to check it out. Since it appeared to be a swollen lymph gland, he was treated with a course of antibiotics. When those antibiotics didn't affect the swelling it was decided to do a biopsy. That happened on August 20th and the results came back "inconclusive".
This led to surgery on August 25 to remove a mass about the size of a small apple. The pathology report came back on August 27 with a diagnosis of Aggressive B-cell Lymphoma. Noah next went through a battery of tests at Hitchcock Center, all of which came back negative ... no sign of cancer in his bone marrow (thank God) and no masses that could be detected in any of his scans. The pathology, however now indicated that the lymphoma was a very rare form of Burkitt's Lymphoma, a very aggressive cancer. Noah and his parents were informed of the recommended course of treatment.
Hitchcock Center is one of only a few treatment centers in the country that are administering a radical new treatment for this type of lymphoma. Noah couldn't be in a better place. The next six months will be very difficult to be sure, but the prognosis is very good because this was caught so early, because aggressive cancers are most responsive to treatment, and, of course, because Noah is young, strong and has a great attitude.
Drugs include: cyclophosphamide, cytarabine, dexamethasone, doxorubicin hydrochloride, etoposide, filgrastim, ifosfamide, leucovorin calcium, methotrexate, prednisone, rituximab, vincristin. Treatment strategies include: antibody therapy, biological therapy, chemotherapy, colony-stimulating factor therapy, cytokine therapy, and monoclonal antibody therapy.
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Sarah (Goodrich) and Noah |
Quilt Given to Noah by the Salt Bay Survivors (Sarah's Clergy Group) | Picture of the Chemo Progress Wheel (made by Tom Wilson) |
vincristine IV over 10 minutes and methotrexate IV over 24 hours on day 1;
leucovorin calcium IV over 15 minutes every 6 hours on day 2;
cytarabine IV over 2 hours daily and etoposide IV over 1 hour daily on days 4 and 5;
oral dexamethasone daily on days 1-5;
and methotrexate and cytarabine intrathecally (IT) on day 1.
During course 2, patients receive rituximab IV over 1-4 hours on days 8, 10, and 12.
Patients also receive filgrastim (G-CSF) subcutaneously (SC) beginning on day 7 and continuing until blood counts recover.
Patients receive cyclophosphamide IV over 5-15 minutes daily on days 1-5;
vincristine IV over 10 minutes and methotrexate IV over 24 hours on day 1;
leucovorin calcium IV every 6 hours on day 2;
doxorubicin IV daily on days 4 and 5; oral dexamethasone daily on days 1-5;
methotrexate and cytarabine IT on day 1; and rituximab IV over 1 hour on day 8.
Patients also receive filgrastim (G-CSF) subcutaneously (SC) beginning on day 7 and continuing until blood counts recover.
vincristine IV over 10 minutes and methotrexate IV over 24 hours on day 1;
leucovorin calcium IV over 15 minutes every 6 hours on day 2;
cytarabine IV over 2 hours daily and etoposide IV over 1 hour daily on days 4 and 5;
oral dexamethasone daily on days 1-5;
and methotrexate and cytarabine intrathecally (IT) on day 1.
During course 4, patients receive rituximab IV over 1 hour on day 8.
Patients also receive filgrastim (G-CSF) subcutaneously (SC) beginning on day 7 and continuing until blood counts recover.
vincristine IV over 10 minutes and methotrexate IV over 24 hours on day 1;
leucovorin calcium IV every 6 hours on day 2;
doxorubicin IV daily on days 4 and 5; oral dexamethasone daily on days 1-5;
methotrexate and cytarabine IT on day 1; and rituximab IV over 1 hour on day 8.
Patients also receive filgrastim (G-CSF) subcutaneously (SC) beginning on day 7 and continuing until blood counts recover.
Patients receive ifosfamide IV over 1 hour daily on days 1-5;
vincristine IV over 10 minutes and methotrexate IV over 24 hours on day 1;
leucovorin calcium IV over 15 minutes every 6 hours on day 2;
cytarabine IV over 2 hours daily and etoposide IV over 1 hour daily on days 4 and 5;
oral dexamethasone daily on days 1-5;
and methotrexate and cytarabine intrathecally (IT) on day 1.
During course 6, patients receive rituximab IV over 1 hour on day 8.
Patients also receive filgrastim (G-CSF) subcutaneously (SC) beginning on day 7 and continuing until blood counts recover.
vincristine IV over 10 minutes and methotrexate IV over 24 hours on day 1;
leucovorin calcium IV every 6 hours on day 2;
doxorubicin IV daily on days 4 and 5; oral dexamethasone daily on days 1-5;
methotrexate and cytarabine IT on day 1; and rituximab IV over 1 hour on day 8.
Patients also receive filgrastim (G-CSF) subcutaneously (SC) beginning on day 7 and continuing until blood counts recover.