News
Article
Childhood Lymphoma: Raising Awareness for Early Detection and Better Outcomes
Author(s):
Key Takeaways
- Lymphoma is the third most common cancer in US children, with Hodgkin and non-Hodgkin types affecting them differently.
- Common symptoms include swollen lymph nodes, fever, and fatigue, with diagnosis involving medical history, exams, and tests.
Although more common among adults, lymphoma is the third most common form of cancer in children in the United States, with about 2200 individuals under age 20 years diagnosed with lymphoma each year.1
In recognition of Childhood Cancer Awareness Month in September, it is important to educate and bring awareness to childhood lymphoma, its symptoms, treatment options, and the need for support.
Lymphoma occurs when white blood cells in the immune system known as lymphocytes grow and multiply uncontrollably. There are many types of lymphoma, including Hodgkin lymphoma and non-Hodgkin lymphoma. Hodgkin lymphoma most commonly affects children 15 years and older. While doctors don’t know what causes Hodgkin lymphoma, there is a connection between Hodgkin lymphoma and Epstein-Barr virus, which causes mononucleosis. Non-Hodgkin lymphoma affects children differently than adults and tends to be more aggressive and fast-growing.
Although specific lymphoma symptoms can vary according to disease type, the most common childhood lymphoma symptoms include painless swelling or enlargement of lymph nodes, excessive night sweats, unexplained fever, unexplained weight loss, loss of appetite, itchy skin, and fatigue.2 Additionally, non-Hodgkin lymphoma symptoms can include swollen abdomen, feeling full after a small meal, and shortness of breath or cough.
Most of the time, these symptoms are not caused by lymphoma, but it is important to recognize these early signs since they may signal other health problems.
In addition to gathering information on a patient’s medical history and performing a physical exam, there are several tests available to help identify childhood lymphoma, including blood tests, bone marrow biopsy, biopsy, and imaging.3 These tests allow the doctor to detect enlarged lymph nodes and to see if the lymphoma has spread to other parts of the body. For example, an ultrasound may be used to examine enlarged lymph nodes in the abdomen and other organs such as the kidneys or testes, to determine if lymphoma is present.
While treatment depends on the patients’ age, general health, and the type and stage of cancer, researchers are studying current therapies for possible use in children and young adults, including chemotherapy, external beam therapy (EBT), monoclonal antibody therapy, chimeric antigen receptor T-cell therapy, ALK inhibitors, and stem cell transplant.
For example, rituximab is a type of monoclonal antibody used to treat severe types of childhood non-Hodgkin lymphoma.4 Pembrolizumab is also a monoclonal antibody used to treat primary mediastinal large B-cell lymphoma that has not responded to treatment or has recurred. However, treatment with pembrolizumab has mostly been studied in adult patients.
Precision medicine is also an innovative approach to treating childhood lymphoma. Precision medicine is described an “emerging approach for disease treatment and prevention that takes into account individual variability in genes, environment, and lifestyle for each person,” according to the Precision Medicine Initative. However, the process of profiling and recruiting young patients in precision medicine clinical trials has highlighted significant limitations.5,6
“Taken together, on completion of the first generation of large-scale pediatric precision medicine studies, there remains significant variation in the sequencing technologies used, the bioinformatic pipelines used to identify molecular abnormalities, and the definitions of actionability,” wrote the researchers of one study.6
While the survival rate for children who have non-Hodgkin lymphoma varies depending on lymphoma type, between 70% and 90% of children are alive for more than 5 years after diagnosis.7
Childhood cancer survivors often experience early-onset conditions, including secondary cancers, cardiovascular disease, and metabolic issues.8 Therefore, it is important to be informed on the long-term health challenges associated with accelerated aging in childhood cancer survivors.
Additionally, many childhood cancer survivors experience significant gaps in care when transitioning from pediatric oncology to adult health care systems. Not only is it important to raise awareness to help identify early signs of childhood lymphoma, but it is important to educate individuals on long-term health challenges to support better outcomes.
“The reason why it’s important to identify an appropriate bridge is because the time at which the patient is transitioning is the time when they’re at the highest risk of developing late effects of therapy,” said Saro H. Armenian, DO, MPH, hematologist-oncologist, City of Hope, in an interview with OncLive®. “These include different cancers, cardiovascular issues, and bone issues. If that transition doesn’t happen smoothly and comprehensively, then many of these patients fall through the gaps. As a result of that, many of the health conditions they develop when they are in their 20s, 30s, and 40s are under diagnosed and not treated appropriately or not prevented.”
References
1. Pediatric lymphomas. Memorial Sloan Kettering Cancer Center. Accessed October 8, 2024. https://www.mskcc.org/pediatrics/cancer-care/types/pediatric-lymphomas
2. Childhood lymphoma symptoms. MD Anderson Cancer Center. Accessed October 8, 2024. https://www.mdanderson.org/cancer-types/childhood-lymphoma/childhood-lymphoma-symptoms.html
3. Radiological Society of North America (RSNA) and American College of Radiology (ACR). Child and young adult lymphoma. Radiologyinfo.org. Accessed October 8, 2024. https://www.radiologyinfo.org/en/info/lymphoma-pediatric#:~:text=NHL%20in%20young%20people%20is,in%20children%20and%20young%20adults
4. Childhood non-hodgkin lymphoma treatment. NCI. Accessed October 8, 2024. https://www.cancer.gov/types/lymphoma/patient/child-nhl-treatment-pdq#:~:text=Rituximab%20is%20used%20to%20treat,been%20mostly%20studied%20in%20adults
5. What is precision medicine? MedlinePlus. Accessed October 8, 2024. https://medlineplus.gov/genetics/understanding/precisionmedicine/definition/
6. McCabe MG, Geoerger B, Chesler L, et al. Precision medicine for childhood cancer: current limitations and future perspectives. JCO Precis Oncol. 2024;(8). doi:10.1200/po.23.00117
7. Scott R. Childhood cancer awareness month shines a light on treatment interventions and advancements. OncLive. Published September 28, 2024. Accessed October 8, 2024. https://www.onclive.com/view/childhood-cancer-awareness-month-shines-a-light-on-treatment-interventions-and-advancements
Oncology Onward: A Conversation With Penn Medicine's Dr Justin Bekelman
