• Hodgkin Lymphoma in Children

    Hodgkin lymphoma is a type of cancer that causes cells in the lymphatic system to abnormally reproduce, eventually making the body less able to fight infection. It is the most common cancer in people ages 15 to 19, and also one of the most treatable.

    Distinguished from other types of lymphoma by the presence of Reed-Sternberg cells, Hodgkin lymphoma usually begins in the lymph nodes of one part of a child's body, usually the head, neck or chest, and then tends to spread in a predictable manner from one part of the lymphatic system to the next. In advanced stages, the disease can spread to the lungs, liver, bones, bone marrow or other organs.

    There are two types of Hodgkin lymphoma:

    • Classical Hodgkin lymphoma, the more common type of disease, characterized by the presence of large, abnormal Reed-Sternberg cells
    • Nodular lymphocyte predominant, a rare type involving variants of Reed-Sternberg cells called "popcorn" cells because of their appearance

    Hodgkin Lymphoma Treatment at Dana-Farber/Boston Children's

    Children and young adults with Hodgkin lymphoma are treated at Dana-Farber/Boston Children's Cancer and Blood Disorders Center through our Lymphoma Program.

    Continue reading to learn more about Hodgkin lymphoma or visit the Lymphoma Program homepage to learn about our expertise and treatment options for this condition.

    What are the symptoms of Hodgkin lymphoma in children?

    The symptoms of Hodgkin lymphoma include:

    • Painless swelling of lymph nodes in the neck, underarm, groin or chest
    • Dyspnea – difficulty breathing due to enlarged lymph nodes in the chest
    • Cough
    • Persistent fever
    • Night sweats
    • Fatigue
    • Weight loss
    • Pruritus (itchy skin)

    It is important to note that many of these symptoms relate to causes other than cancer.

    How is pediatric Hodgkin lymphoma diagnosed?

    In addition to a complete physical examination, doctors diagnose Hodgkin lymphoma with:

    • Blood tests: Such tests could include a complete blood count, blood chemistry and erythrocyte sedimentation rate (ESR) to look for evidence of inflammation.
    • Chest X-ray: These images will help identify presence of disease in the chest.
    • Computerized tomography (CT or CAT) and positron emission tomography (PET) scans: These other types of imaging will likely be performed to understand all sites of disease in the body before treatment begins.
    • Surgical biopsy: A tissue sample is removed from the tumor site while the patient is under anesthesia so that a pathologist may look at the cells closely under the microscope and help make the diagnosis.
    • Bone marrow biopsy and aspiration: Bone marrow is removed from the bone (usually the back of the hipbone) to help determine if there is disease in this location. This procedure is usually only performed in patients with evidence of advanced disease.

    After all tests are completed, doctors will be able to outline the best treatment options.

    How are children with Hodgkin lymphoma treated?

    The course of treatment for Hodgkin lymphoma depends on many factors, such as the stage of the tumor, and may include the following, alone or in combination:

    • Chemotherapy: A drug treatment that interferes with the cancer cell's ability to grow or reproduce. For some types of cancer, chemotherapy is used alone, while in others it is used in combination with another therapy or therapies.
    • Radiation therapy: Uses high-energy rays (radiation) from a specialized machine to damage or kill cancer cells and shrink tumors. Radiation treatment is considered based on the tumor's initial stage at diagnosis and its response to chemotherapy.
    • Surgery: May be used to treated lymphocytic predominant disease that involves only one lymph node, but is not used to treat classical Hodgkin lymphoma.
    • Stem cell transplant: Often used when the lymphoma progresses despite initial treatment or when it relapses. Stem cell transplantation for patients with Hodgkin lymphoma most often involves collecting stem cells from the patient before giving very high doses of chemotherapy that, as a side effect, cause the patient's bone marrow to no longer function properly. After the high-dose chemotherapy, the patient's stem cells that were already collected are given back and the bone marrow is able to function again.

    What are the treatment options for progressive or recurrent Hodgkin lymphoma?

    Treatment of recurrent Hodgkin lymphoma depends on where the disease recurs, previous treatments and the time since the first treatment was completed. These treatments include:

    We also offer innovative clinical trials for children with Hodgkin lymphoma. Some of these were launched by our own physicians, while others are available in collaboration with the Children's Oncology Group (COG), St. Jude Children's Research Hospital and other national and international groups. Clinical trials may also be available through our collaboration with pharmaceutical companies.

    Should you have questions or need advice on whether a particular trial would be appropriate for your child, email our clinical trials team at clinicaltrials@danafarberbostonchildrens.org. We can help you navigate your options.

    What is the long-term outlook for a child with Hodgkin lymphoma?

    Both classical and nodular lymphocyte predominant Hodgkin lymphoma are highly curable, with survival rates between 90 and 95 percent.

    Children and adolescents may have treatment-related side effects that can appear months or years after treatment, including problems with bone growth and development of sex organs in males, infertility, and thyroid, heart and lung diseases. As many as 30 percent of patients who survive childhood Hodgkin lymphoma develop a secondary cancer after diagnosis, primarily breast cancer, non-Hodgkin lymphoma, thyroid cancer or acute leukemia. Many current treatment regimens and research studies now focus on trying to decrease the risk for these late effects.

    For these reasons, survivors of childhood Hodgkin lymphoma should receive regular follow-up monitoring and care at a cancer survivorship program. Since 1993, physicians, nurses, researchers and psychologists in our cancer survivorship program at the David B. Perini, Jr. Quality of Life Clinic at Dana-Farber/Boston Children's have helped thousands of survivors of pediatric cancers, treated at the Institute and at other hospitals in New England and elsewhere, to manage the long-term consequences of their disease.

    What is the latest research on pediatric Hodgkin lymphoma?

    Given the very high survival rate for patients with Hodgkin lymphoma, many research studies now focus on learning how to eliminate potential late effects (e.g., secondary cancers) while maintaining excellent outcomes. This involves trying to determine when some treatments, like radiation, may be safely eliminated from a treatment plan. New treatments designed to direct the immune system against specific cancer cells – called immunotherapy – are also under study.
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    Dana-Farber/Boston Children's has one of the largest and most experienced pediatric stem cell transplant programs in the United States. Watch Dr. Leslie Lehmann explain how stem cell transplants work.