B-cell lymphoma unclassifiable with features intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma

My 86-year old neighbor was just diagnosed with either "diffuse large B-cell lymphoma" or "B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma" - the doctors are still trying to make the determination on which it is but they say it's one of those two.
This gentleman is in great shape for his age - lives alone and does all his own work around the house. He found out that he had this when he complained of abdominal pain and they ended up removing about 10" of small and large intestine. It's very early stages which is good.
We'll find out in 4 days exactly which it is and what they're recommending for treatment - although I think it's 6 rounds of R-CHOP either way.
Has anyone heard of "B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma" which is a newer classification if I understand correctly.
Much thanks.

this classification is the kind of thing that happens in lymphoma all the time-- a B-cell cancer is examined and doesn't fall precisely in line with any of the established classifications. it's one reason why the global standards for classification have changed so often, and will no doubt change again soon.

the reality here is that while for most lymphomas the treatment protocol will differ vastly from one subtype to the next, in the case of DLBCL and Burkitt's, this probably won't be true because they're very similar (oops just read he's getting "R-CHOP either way"). the fact that it's in the early stages is indeed good, but on the whole the prognosis for DLBCL is better than it is for Burkitt's because the latter is about as aggressive a cancer as you'll find in lymphoma.

Now the more aggressive the cancer, generally, the more effective the chemo, and this is often true with B-cell lymphomas. his docs clearly think he can handle the chemo, otherwise they wouldn't risk giving it to him, but R-CHOP has one chemo drug that can damage the heart and lungs so I hope he'll be ok in that regard.

to answer your actual question, I have certainly heard of this 'diagnosis', and ones like it are not uncommon in lymphomas. it's likely that they've found a precedent for his cancer by the use of immunophenotyping or through cytogenetics-- lab techniques that can narrow down a lymphoma dx. although my guess is his doctors think it's much closer to DLBCL than Burkitt's because R-CHOP is standard for DLBCL, but it's not considered adequate for Burkitt's--normally a Burkitt's patient would get something like CODOX-M, or EPOCH, or HyperCVAD.


Ross - thanks for your feedback. We got “good” news today that Dana Farber has identified it as DLBCL and NOT the Burkitt-like cancer. He would have had R-CHOP either way but knowing that it’s not designed for the more aggressive cancer I’m not sure how much it would have done anyway. They would not even consider doing the more appropriate regimen (as you mentioned) should he have had the burkitt-like cancer.
He’s has had an echo cardiogram with excellent results. We’ve been introduced to the chemo meds, side-effects and he’ll start chemo in one week. I’m sure I’ll be back with questions as this gets rolling. Thanks again!!

Sounds good. Below is a link to a page that features a link to a PDF file entitled "Lymphoma in Later Life" which addresses some of the difficulties faced by elder folks dealing with lymphoma and their treatments, it might be helpful both to him and to those looking after him, such as yourself.

"Lymphoma in Later Life" from the Lymphoma Association UK.


I also have multiple dx on my pathology report. The mildest (I think) being Follicular with the others being DLBCL and Burkitt. I have nodes as large as 4.2 CM and am quite symtomatic so I don't think it will be Folicular. I imagine DLBCL will turn out to be the one.