Non-Hodgkin lymphoma (NHL) is not just one disease but a
group of cancers that originate in cells of the immune system, called
lymphocytes. (See types of non-Hodgkin lymphoma section below.)
Children with non-Hodgkin lymphoma are treated at
Dana-Farber/Boston Children's through the Lymphoma
Program in our Hematologic Malignancies Center.
One of the top pediatric cancer centers worldwide, Dana-Farber/Boston
Children’s combines the expertise of a premier cancer center – Dana-Farber
Cancer Institute – and a world-class children’s hospital – Boston Children’s
Hospital – to provide internationally-renowned care for children with cancers
of the blood and immune system.
The lymph system is part of the immune system and is made up
of the following:
The World Health Organization (WHO) divides non-Hodgkin lymphoma
into different categories based on various features of the lymphoma, such as the
type of lymphocyte that has become cancerous. The two types of lymphocytes that
most commonly cause lymphomas are B-cells and T-cells. Within each of these cell
types, the cancer may grow from immature cells or mature cells. Therefore, most
non-Hodgkin lymphomas fall into one of three groups:
Treatment for non-Hodgkin lymphoma depends on the particular
To determine the correct diagnosis, expert pathologists
examine the lymphoma under the microscope and use specialized molecular tests.
The pathologist evaluates many features of the cancer, including the size, shape
and physical details of the tumor cells, the pattern of how the cells are arranged
within the tumor, the presence of certain proteins and gene markers that the tumor
cells express, and certain details of how the lymphoma presents in the patient.
Within the WHO classification of NHL, most non-Hodgkin lymphomas
of children and adolescents are one of the following types:
Immature B and T-Cell
Non-Hodgkin lymphoma is sometimes categorized according to
where it arises in the body.
Doctors do not know what causes most cases of non-Hodgkin lymphoma.
The majority of instances of NHL in children are not caused by anything that
can be prevented.
There are some known risk factors that might increase a
child’s likelihood of developing non-Hodgkin lymphoma. These affect only a
small percentage of children. Risk factors include:
Non-Hodgkin Lymphoma symptoms
Non-Hodgkin lymphoma symptoms vary depending on the type of
lymphoma (see types of lymphoma section above) and where the lymphoma is
located. Sometimes symptoms of generalized illness, such as fever, night
sweats and weight loss, may go along with NHL. These symptoms are referred to
as “B” symptoms. Other times, there are no symptoms except an enlarging lymph
node or lump. The disease can progress quickly over days to weeks or can have a
very slow pace of progression over many months.
The location where the lymphoma is growing in the body often
explains the symptoms.
Non-Hodgkin lymphoma symptoms may resemble those of other more common
medical problems. It is important to have your child evaluated by a qualified
medical professional for an accurate diagnosis.
The first step in treating NHL is making an accurate
diagnosis. When the symptoms and findings on physical examination raise the
possibility of a non-Hodgkin lymphoma diagnosis, laboratory tests and radiology
tests will usually be done to help guide how best to determine the diagnosis.
To make a definite non-Hodgkin lymphoma diagnosis, a sample of the tumor needs
to be obtained for evaluation by the pathologist. This usually is done by
having a surgeon or interventional radiology doctor remove a piece of tumor
(biopsy). Sometimes the diagnosis may be made by evaluating fluid removed for
the chest or abdomen or by removing a small piece of bone marrow to be examined
under the microscope.
The second step in treating NHL is to determine how much the
disease has spread within the body. The extent of disease is called the “stage”
of the lymphoma. Knowing the stage helps to determine the strength of the
treatment that is needed to cure the lymphoma. The process of finding all of the
sites of disease in the body is called “staging”. Staging involves doing
radiology tests, such as PET, CT, and MRI scans; sampling the bone marrow with
a needle into the hip bones; and obtaining spinal fluid with a needle into the
space between the bones of the lower spine (lumbar puncture).
The information learned from the scans and from the bone
marrow and spinal fluid evaluations is used to assign a “stage” that describes
how extensive the lymphoma is. More than one staging system is used for non-Hodgkin
lymphoma. Whereas in adult non-Hodgkin lymphoma, a system called the Ann Arbor
Staging System is commonly used, in childhood non-Hodgkin lymphoma, the most common
system of staging is the St. Jude/ Murphy Staging System. This system is summarized
Because the common childhood non-Hodgkin lymphomas often are
located in the chest, abdomen, or next to the spine or brain, many children
with non-Hodgkin lymphoma have stage III or IV disease when they are diagnosed.
The major factor in deciding the treatment strategy for non-Hodgkin
lymphoma is the specific type of lymphoma. The other important consideration is
whether the cancer is localized to a specific part of the body (low stage; stage
I or II) or has spread to different parts of the body (advanced stage; stage
III or IV). Generally, stronger treatment is needed for successful treatment of
advanced stage lymphoma.
Non-Hodgkin lymphoma treatment may include:
The lymphoma specialists at Dana Farber/Boston Children’s
determine the best treatment approach for each child's unique situation, based
on the type of lymphoma, the extent of the disease, the patient’s medical
condition, the patient and family’s preferences, and the most up-to-date
medical knowledge about lymphoma therapies.
For many children with cancer, clinical trials – research studies
evaluating new treatment approaches – provide state-of-the art treatments and new
opportunities for cure. Dana-Farber/Boston Children’s offers many clinical
trials. It is possible your child will be eligible to participate in one of our
lymphoma clinical trials. Participation in a clinical trial is optional and is
never a requirement to receive treatment at Dana-Farber/Boston Children’s.
In addition to launching our own clinical trials, we also
offer trials available through collaborative groups such as the Children's
Oncology Group (COG), the Therapeutic Advances in Childhood Leukemia and
Lymphoma (TACL) group, and the Pediatric Oncology Experimental
Therapeutics Investigators' Consortium (POETIC). We are the New England Phase I
Center of the Children's Oncology Group.
We have new treatments under investigation, both for newly
diagnosed lymphomas and for lymphomas that have come back after initial
treatment. New and experimental treatments include monoclonal antibody
therapies, antibody-drug conjugates and bispecific antibodies that specifically
target tumor cells; small molecule inhibitors that interfere with the way
cancer cells grow; checkpoint inhibitors that activate the body’s own immune
system to fight the cancer; and selective inhibitors of nuclear export that
prevent tumor cells from escaping cell death. Clinical trials to investigate
the biology of each child’s lymphoma are available and may help find targets of
therapy unique to that lymphoma.
To learn more about the specific clinical trials that are
currently available at the Dana-Farber/Children’s Hospital Cancer Center:
The long-term outlook for children with non-Hodgkin lymphoma
is excellent. More than 80 percent of children are cured and can resume a
normal life, returning to school, social activities and athletics, typically within
a year after diagnosis.
Cancer survivorship care
All kids who have been treated for cancer require ongoing,
specialized care. Through the David
B. Perini, Jr. Quality of Life Clinic, our cancer
survivorship clinic, childhood cancer survivors receive regular,
comprehensive follow-up evaluations from their cancer care team. In addition to
meeting with your pediatric oncologists, your child may see one of our endocrinologists, cardiologists, neurologists, neuro-psychologists or alternative/complementary therapy specialists. We also offer patient and
family education, psychosocial assessment, genetic counseling, reproductive
counseling and opportunities to speak with other childhood cancer
Phone: 617-632-5508Online form: Request an appointment
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