the gmall-b-all/nhl2002 protocol, the modified magrath regimen (r-codox-m/ivac). copadm, hyper-cvad, and the cancer and leukemia group b (calgb) 8811 regimen; these can be associated with rituximab. in older patients, treatment may be dose-adjusted epoch with rituximab. the effects of the chemotherapy, as with all cancers, depend on the time of diagnosis. with faster-growing cancers, such as burkitt, the cancer actually responds faster than with slower-growing cancers. this rapid response to chemotherapy can be hazardous to the patient, as a phenomenon called "tumor lysis syndrome" could occur. close monitoring of the patient and adequate hydration is essential during the process. since burkitt lymphoma has high propensity to spread to the central nervous system (lymphomatous meningitis), intrathecal chemotherapy with methotrexate and/or ara-c and/or prednisolone is given along with systemic chemotherapy. chemotherapy cyclophosphamide doxorubicin vincristine methotrexate cytarabine ifosfamide etoposide rituximab other treatments for burkitt lymphoma include immunotherapy, bone marrow transplants, stem cell transplant, surgery to remove the tumor, and radiotherapy. prognosis the prognosis for burkitt lymphoma is superior in children and increased age is a negative prognostic indicator. the overall cure rate for sporadic burkitt lymphoma in developed countries is about 90%. in adults, burkitt lymphoma is uncommon and has poor outcomes. unsatisfactory initial response to the treatment of burkitt lymphoma with cyclophosphamide, vincristine, and prednisolone indicates a negative prognosis. furthermore, failed initial treatment and return of burkitt lymphoma after a six-month stint of time serve as a poor prognostic indicator. the adequate utilization of therapeutic drugs during initial treatment limits additional treatment options following the return of the disease. notably, in areas of the world where the initial treatment of burkitt lymphoma is inadequate further treatment options may remain for cases when the disease returns. laboratory studies such as lactate dehydrogenase (ldh), cd4 count, and other cytogenetic studies are also prognostic indicators. unsatisfactory outcomes have been associated with an ldh that is found to be two times above the upper limit of normal. specifically, there is a poor prognosis associated with a cd4 count that is decreased in the immunodeficiency-associated variant of burkitt lymphoma. genetic mutations extending beyond the previously described myc translocation may also serve as negative prognostic indicators. some notable genetic findings that may be associated with poor outcomes include: 13q deletion, 7q gain, id3 and ccnd3 double-hit mutations, and 18q21 cn-loh mutations. the prognosis for burkitt lymphoma can be better determined following staging utilizing imaging modalities such as positron emission tomography and computed tomography scans where tumor burden and invasion of the central nervous system have been found to indicate a poor prognosis. epidemiology as a non-hodgkin lymphoma (nhl), burkitt lymphoma makes up 1-5% of cases, and it is more common in males than females with a 3–4 to 1 ratio. the endemic variant mainly impacts areas with an increased prevalence of malaria and ebv in africa and papua new guinea. for children less than 18 years of age from equatorial africa, the annual incidence of burkitt lymphoma is 4–5/100,000. additionally, in equatorial africa, 50% of tumors that are diagnosed during childhood as well as 90% of lymphoma cases can be attributed to burkitt lymphoma. the peak incidence for endemic burkitt lymphoma is from ages 4 to 7 with an average age of 6 years. the sporadic variant with an annual incidence 2-3/million is more commonly found in north america and europe comprising 1-2% of adult lymphomas and 30–40% of nhl cases. this variant is 3.5 times more commonly found in males compared to females and it is more frequent in younger individuals. the sporadic variant has a peak incidence at 11 years of age in children, and diagnosis typically occurs from 3–12 years of age on average. for adults, 45 years was the median age that the sporadic burkitt lymphoma was diagnosed. the immunodeficiency-associated variant predominantly impacts the hiv-infected population. for those in the united states and with aids, the incidence of this variant was found to be 22/100,000 person-years. there is also an increased risk of developing this variant of burkitt lymphoma for individuals that have received an organ transplant after 4–5 years. ebv infection is associated with burkitt lymphoma. ebv is found in virtually all instances of endemic burkitt lymphoma. the sporadic variant of burkitt lymphoma is associated with ebv in only 10–20% of cases. approximately 30% of immunodeficiency-associated burkitt lymphoma cases were associated with ebv. research gene targets unique genetic alterations promote cell survival in burkitt lymphoma, distinct from other types of lymphoma. these tcf3 and id3 gene mutations in burkitt correspond to a cell survival pathway that may be found to be amenable to targeted therapy.