Working Diagnosis:
Burkitt Lymphoma

Treatment:
The patient was immediately admitted to a medical oncology service and high intensity chemotherapy was initiated, which has shown to improve overall survival with Burkitt lymphoma. Pretreatment labs revealed he was HIV positive, so he was started on Biktarvy. Additionally, he was prescribed acyclovir and bactrim for prophylaxis against opportunistic infections.

Outcome:
At his follow up oncology appointment 5 months post-diagnosis, he had been doing well with some expected side effects from chemotherapy. He was taking gabapentin for neuropathy and oxycodone as needed for pain. Since initiating chemotherapy, he has had marked improvement in the size of the chest wall mass and near complete resolution of axillary lymphadenopathy.

Author's Comments:
Burkitt lymphoma is a rare and highly aggressive B-cell lymphoma commonly associated with EBV. It has three clinical variants. The immunodeficiency-related variant is seen in patients with HIV or organ transplants. It presents as a rapidly growing mass, typically with lymph node and CNS involvement. The most common extra-nodal sites are the GI tract and bone marrow. In this case, the patient was found to be HIV positive incidentally on pre-chemo labs and the mass was located in the chest wall. Due to the location, it was initially thought to be a sarcoma. Interestingly, the patient also had no constitutional symptoms. The prognosis for Burkitt lymphoma tends to be poor in adults but excellent in children.

Editor's Comments:
As a sports medicine physician it is important to follow and counsel patients after a lymphoma diagnosis. After the cancer diagnosis is confirmed and the treatment has been implemented by the surgeons and oncologist, follow up on these patients is crucial. Pophali et. al showed that not only does baseline higher levels of physical activity lead to higher survival rates, but the rate of increase in physical activity after diagnosis had a stronger association with survival than baseline physical activity alone and this association was linear. Sports Medicine physicians have the knowledge and expertise to provide guidance and counsel on physical activity, which is key to quality of life and survival in lymphoma patients.

References:
Crombie J, LaCasce A. The treatment of Burkitt lymphoma in adults. Blood (2021) 137 (6): 743–750.
Roschewski M, Staudt LM, Wilson WH. Burkitt’s Lymphoma. N Engl J Med. 2022;387(12):1111-1122. doi:10.1056/NEJMra2025746.
Pophali PA, Ip A, Larson MC, Rosenthal AC, Maurer MJ, Flowers CR, Link BK, Farooq U, Feldman AL, Allmer C, Slager SL, Witzig TE, Habermann TM, Cohen JB, Cerhan JR, Thompson CA. The association of physical activity before and after lymphoma diagnosis with survival outcomes. Am J Hematol. 2018 Dec;93(12):1543-1550.

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