Here at Children’s Hospital Boston, we provide innovative family centered care to support your family’s physical and psychosocial needs. We understand that you may have a lot of questions when your child is diagnosed with non-Hodgkin lymphoma, including:
- What is it?
- What can we do about it?
- How will it affect my child long-term?
We’ve provided some answers to these questions here, and when you meet with our experts, we can talk with you more about your child’s diagnosis and treatment.
What is the lymphatic system?
Will it spread to other organs of my child’s body?
There are many different parts of the body that are part of the lymph system, thus non-Hodgkin lymphoma can start and spread anywhere in the body including the bones, bone marrow, spinal fluid, the liver, kidneys and lungs. Usually the success of treatment is the same whether or not the cancer has spread beyond the lymph system.
What is the difference between non-Hodgkin lymphoma in children and adults?
The common kinds of non-Hodgkin lymphoma differ greatly between children and adults. Many lymphomas in adults are low or intermediate grade. Most lymphomas in children are high grade which is associated with a favorable response to chemotherapy.
Major types of childhood non-Hodgkin lymphoma
- Burkitt’s lymphoma
- diffuse large B-cell lymphoma
- lymphoblastic lymphoma
- anaplastic large cell lymphoma
There are several types of non-Hodgkin lymphomas, classified based on the size and shape of the lymphoma cells under a microscope, and how the cells grow within the lymph nodes and beyond.
What is Burkitt’s lymphoma?
- Burkitt's lymphoma consists of small cells that are “noncleaved”, meaning they have no folds or indentations when viewed under a microscope.
- Burkitt's lymphoma involves mature B-cells and is a rapidly growing cancer. Involvement of the gastro-intestinal tract is common.
Types of large cell lymphoma
The main subtypes of large cell lymphomas are:
Diffuse large B-cell lymphoma. anaplastic large cell lymphoma (ALCL)Large cell lymphoma accounts for about 30 percent of non-Hodgkin lymphomas in children. Diffuse large B-cell lymphoma can arise in many parts of the body and is often treated the same way as Burkitt’s lymphoma. Anaplastic large cell lymphoma (ALCL) usually arises from T-cells. Although low stage ALCL may be treated the same as other low stage NHL’s, high stage ALCL usually has a unique treatment strategy.
Is it life-threatening?
Non-Hodgkin lymphoma can be life threatening if it goes untreated. But after treatment, it’s cured more than 80 percent of the time: It never comes back again and the patient fully recovers.
What causes non-Hodgkin lymphoma?
Doctor’s aren’t sure what causes non-Hodgkin lymphoma. There has been no evidence to suggest that it is caused by anything that can be prevented, and there is nothing that you or your child did or did not do that caused the cancer.
There are some risk factors that might increase a child’s likeliness of developing non-Hodgkin lymphoma. These affect only a tiny percentage of those affected, and include:
- being born with a condition that weakens the immune system, such as Wiskott-Aldrich syndrome, ataxia-telangiectasia or common variable immunodeficiency
- having a weakened immune system as a result of an acquired disease or condition, or as a result of having had an organ transplant
- exposure to viral infections
- chemotherapy and radiation therapy from other cancer treatments
There has been much investigation into the association of non-Hodgkin lymphoma with:
- the Epstein-Barr virus (EBV), which causes the infection mononucleosis (mono)
- human immunodeficiency virus (HIV), which causes acquired immune deficiency syndrome (AIDS)
What is the relationship between chromosomes and non-Hodgkin lymphoma?
The majority of Burkitt's lymphoma cases have a chromosome rearrangement between chromosome #8 and #14, which causes genes to change positions and function differently, promoting uncontrolled cell growth. This DNA change occurs within the lymphoma cells but not in the normal healthy cells in the patient’s body.
Other chromosome rearrangements occur in non-Hodgkin lymphoma (all types) are also thought to promote excessive cell growth. Children and adults with other hereditary abnormalities have an increased risk of developing non-Hodgkin lymphoma, including patients with:
- ataxia telangiectasia
- X-linked lymphoproliferative disease
- Wiskott-Aldrich syndrome
Who has the highest risk for developing non-Hodgkin lymphoma?
- It occurs most often in children between ages 15 and 19, and sometimes as early as age 10. Very rarely do children have non-Hodgkin lymphoma before the age of 10.
- Non-Hodgkin lymphoma affects boys almost twice as often as girls, and is more common among Caucasian children than children of other races.
Signs and symptoms
What are the symptoms of non-Hodgkin lymphoma?
Symptoms of non-Hodgkin lymphoma vary depending where the lymphoma starts. The disease can progress quickly—from a few days to a few weeks. Other kinds of non-Hodgkin lymphoma can have minimal symptoms for many months.
Some children with non-Hodgkin lymphoma have symptoms of an abdominal mass and complain of abdominal pain, fever, constipation and decreased appetite. Other children complain of respiratory problems, dyspnea (pain with deep breaths), cough and wheezing.
When respiratory symptoms are present, they can quickly worsen, causing a life-threatening emergency.
While each child may experience symptoms differently, some of the most common include:
- painless swelling of the lymph nodes in neck, chest, abdomen, underarm or groin
- fever without another obvious explanation
- abdominal symptoms such as swelling or cramping
- night sweats
- tiring easily
- non-intentional weight loss
- respiratory symptoms such as shortness of breath, trouble breathing, wheezing, high pitched breathing sounds or swelling of the head or neck
Questions to ask your doctor
We understand that you are an expert on your child, and can play a critical role in the care of your child. Our team of professionals use your knowledge about your own child to help your child through treatment and on through recovery. By asking questions of your child’s doctor, you can help facilitate a conversation between you and your child’s care team. Sometimes, it’s helpful to write your questions down, so you can remember them for the appointment. There are several questions you can ask your child’s doctor, such as:
- How do you decide treatment recommendations?
- How long will my child need to be in the hospital?
- What are the possible short and long-term complications of treatment? How will they be addressed?
- How can I get my child eased back into normal social and school activities after treatment?
How could my child benefit from being part of a research study?
Back to School program At age 11, Ronald (R.J.) Agostinelli was diagnosed with acute lymphoblastic leukemia, a cancer of the white blood cells. He missed seven months of elementary school while having chemotherapy. R.J. talks about what it was like returning to his class after a long absence.