Lymphomas are cancers that develop in the lymph system. The vessels of the lymph system carry a watery like fluid called lymph that contains white blood cells, or lymphocytes, that fight infections. The lymph system connects the lymph nodes in the neck, armpit, and groin with the spleen, thymus, and parts of the tonsils, stomach, and small intestine. Once a malignancy begins in one part of the lymph system, it often spreads throughout the rest of the system before it is detected. Lymphomas present with symptoms such as painless swelling of the lymph nodes, fever and fatigue.

Lymphomas are divided into sub-groups according to the cell types that make up the cancer. Broadly, they are classified as either non-Hodgkin’s and Hodgkin’s. Of these two types, non-Hodgkin’s (NHL) is the more common lymphoma in children, and it occurs more frequently between the ages of ten and twenty than under ten. Hodgkin’s is rare in children under five years of age. In children under age 10, it is more common in boys than in girls.

Non-Hodgkin’s Lymphomas (NHL)

The three types of NHL that occur most often in children are:

• Lymphoblastic: predominantly T-cell origin, sometimes hard to distinguish from leukemia. Accounts for approximately 30% of childhood NHLs.
• Small noncleaved cell lymphoma (Burkitt’s and non-Burkitt’s): B-cell origin, and cALLa (common acute lymphoblastic leukemia antigen). Accounts for 40-50% of childhood NHLs.
• Large cell lymphoma: a heterogeneous group B-cell lineage and T-cell lineage, some are like both T-cell and B-cell. Accounts for 20-25% of childhood NHLs.

NHL is the most frequent malignancy in children with AIDS.

• More information on non-Hodgkin’s lymphomas on the NCI web site – note that you can toggle back and forth between “Health Professional” and “Patient” versions.

Treatment for Non-Hodgkin’s Lymphomas

Treatment for NHL depends on the stage and the type of NHL. In general, NHL is treated with systemic multi-agent chemotherapy as well as treatment of the central nervous system (CNS) when indicated. Chemotherapy drugs can include vincristine, doxorubicin, cyclophosphamide, prednisone, mercaptopurine, methotrexate, and L-asparaginase. Radiation can also be included. High-dose chemotherapy followed by stem cell transplant is sometimes indicated.

• Staging information on the NCI site
  

Hodgkin’s Lymphoma

Hodgkin’s disease is characterized by the presence of large, bi-nucleated cells called “Reed-Sternberg cells” or R-S. Subtypes of Hodgkin’s are determined by the number of R-S cells and other factors.

• More information on Hodgkin’s on the NCI web site – note that you can toggle back and forth between “Health Professional” and “Patient” versions.

Treatment for Hodgkin’s

Treatment for Hodgkin’s depends on several factors including the stage of the cancer:

• Staging information for Hodgkin’s on the NCI site

Patients are designated a risk group. Low risk groups might receive chemotherapy only, while higher risk groups receive more aggressive chemotherapy and radiation. Chemotherapy drugs can include cyclophosphamide, procarbazine, vincristine and/or vinblastine, prednisone or dexamethasone, doxorubicin, bleomycin, dacarbazine, etoposide, methotrexate, and cytosine arabinoside.

Clinical Trials for Lymphomas

Clinical trials for lymphomas can be found by searching the clinical trial database on the NCI web site. Follow these directions:

• Start at the NCI clinical trials search page.
• Choose type of cancer: “lymphoma, non-Hodgkin’s lymphoma, child” or “lymphoma, Hodgkin’s lymphoma, child.”
• You will be given more choices (e.g., type of cancer and type of trial). Choose the appropriate responses and click “search.”

Symptoms of Lymphomas

Symptoms can include:

• swollen lymph node, especially in the neck, armpit or groin (Hodgkin’s disease usually presents with enlarged lymph nodes)
• swelling of the face
• abdominal pain or swelling
• weakness, tiredness
• sweating, especially at night
• unexplained fever
• unexplained weight loss
• shortness of breath, breathing difficulties, occasional cough, high-pitched breathing sounds
• difficulty in swallowing

Statistics

• 7% of childhood cancers
• Third most common childhood malignancy
• 800 cases/year in the US
• More common in ages 10-20
• Very unusual in children under 3 years of age
• NHL has a cure rate of 60%
• Hodgkin’s has a cure rate of 90-95%

Resources

Websites

• Mike’s Lymphoma Resource Pages: A comprehensive lymphoma site with good coverage of pediatric lymphomas.
• Lymphoma Research Foundation (LRF): This is a very comprehensive site. Although it focuses on adult lymphomas, the disease descriptions, staging, grades, support, and treatment sections offer invaluable information to parents of children with lymphomas. This site also keeps tabs on new treatments.
• MD Anderson Cancer Center Children’s Cancer Hospital– MD Anderson’s website contains information on the symptoms, diagnosis, and treatment of childhood cancers. You can also find information about their Childhood Cancer Survivors Clinic, clinical trials, etc.

E-mail Support Lists

• ACOR: ped-lymphoma and ped-onc