Burkitt Lymphoma: Current Understanding, Unmet Needs, and Research Directions.

Abstract

Burkitt lymphoma (BL) is an aggressive B-cell lymphoma historically classified into endemic, sporadic, or immunodeficiency-associated BL based on clinical and epidemiological features. Recent genomic and epigenomic studies have refined this framework, distinguishing EBV-positive and EBV-negative BL molecular subtypes that cut across traditional clinical and epidemiological categories and exhibit distinct biological profiles. In high-income countries, BL is highly curable with intensive multiagent chemotherapy and antibody-based therapy. In contrast, survival in sub-Saharan Africa (SSA) rarely exceeds 50%, reflecting diagnostic delays, limited access to effective treatment, and challenges in supportive care. This review summarizes advances in BL epidemiology, molecular biology, diagnosis, and treatment, highlighting how genomic insights have identified novel biomarkers for earlier detection and monitoring, as well as potential targeted therapies with reduced toxicity. These advances present opportunities to develop scalable diagnostic tools and tailored therapeutic strategies to narrow survival disparities, particularly in resource-limited settings, where most cases occur, and among adults and patients with relapsed or refractory BL in high income countries. We also outline key unanswered questions in BL epidemiology and pathogenesis, discuss opportunities for translational research, and emphasize the need for improved model systems to study therapeutic resistance to close the survival gap.