Non-Hodgkin Lymphoma (NHL)

Non-Hodgkin lymphoma (NHL) in children is a cancer of lymphocytes. Unlike in adults, childhood NHL is almost always fast-growing — but it also responds very well to treatment, and most children are cured.

About pediatric non-Hodgkin lymphoma

What is non-Hodgkin lymphoma?

Lymphocytes grow out of control in lymph nodes or other organs, forming masses that can grow quickly over days to weeks.

What are the risk factors?

• Inherited or acquired immune deficiency (including HIV)
• Medicines that suppress the immune system after an organ transplant
• Epstein–Barr virus infection (especially for Burkitt lymphoma)
• In most children, no risk factor is found

What are the symptoms?

• Rapidly growing, painless lumps in the neck, armpit or groin
• Swelling or pain in the tummy, vomiting or bowel obstruction
• Cough, breathlessness or swelling of the face and neck from a chest mass — an emergency
• Fever, night sweats and weight loss

How many types are there?

• Burkitt lymphoma — very fast-growing, often in the abdomen
• Diffuse large B-cell lymphoma and primary mediastinal B-cell lymphoma
• Lymphoblastic lymphoma — closely related to ALL, often in the chest
• Anaplastic large cell lymphoma — often involves skin and lymph nodes

Because childhood NHL grows quickly, tests are completed within days so that treatment can start safely.

Blood tests

Blood count, LDH, uric acid, kidney and liver function. High uric acid and potassium can signal tumor lysis — a complication we prevent carefully.

Biopsy

A lymph node or mass is sampled (sometimes from fluid around the lungs or abdomen) for diagnosis and subtype.

Chest X-ray

Checks for a chest mass before any sedation.

CT scan

Of the neck, chest, abdomen and pelvis to map the disease.

PET scan

Shows active lymphoma throughout the body and helps judge response.

MRI scan

For the brain, spine or bones when needed.

Ultrasound

A quick, radiation-free way to look at the abdomen and lymph nodes.

Bone marrow aspiration and biopsy and lumbar puncture

Check for spread to the bone marrow and the spinal fluid.

Treatment is matched to the lymphoma subtype and stage. Most children receive chemotherapy over a few months.

Chemotherapy

Combinations of drugs given in cycles; for lymphoblastic lymphoma, treatment is similar to ALL and lasts about two years. Chemotherapy into the spinal fluid protects the brain.

Immunotherapy

Rituximab (anti-CD20) is added for mature B-cell lymphomas. Brentuximab vedotin is used for anaplastic large cell lymphoma.

Targeted therapy

ALK inhibitors such as crizotinib for ALK-positive anaplastic large cell lymphoma.

Radiotherapy

Rarely needed in childhood NHL.

CAR T-cell therapy and stem cell transplant

For lymphoma that relapses or does not respond, CAR T-cell therapy and autologous or allogeneic transplant can offer a cure.

Holistic care

Nutrition, pain control, schooling support and psychological care for children and parents.

Our pediatric lymphoma specialists plan treatment with surgeons, radiologists and pathologists.