Lymphoma in Children: Hodgkin and Non-Hodgkin

Lymphoma is a cancer of the lymphatic system. This is the network of vessels and glands that helps your body fight infection. In children, doctors group lymphoma into two main kinds: Hodgkin lymphoma and non-Hodgkin lymphoma. Both are treatable. Most children do well with modern treatment.

The most common sign in both types is a swollen lymph node. It usually does not hurt, and it does not go away. This often shows up in the neck, chest, underarm, or groin. Other signs can include fever, drenching night sweats, weight loss, and tiredness. Some children get itchy skin. A lump in the chest can press on the airway. That can cause coughing, wheezing, or trouble breathing.

Hodgkin lymphoma tends to spread in a predictable pattern. It moves from one group of lymph nodes to the next nearby group. Doctors confirm it with a lymph node biopsy. They look for a specific abnormal cell called a Reed-Sternberg cell. Treatment usually combines chemotherapy with radiation therapy for some children. The exact plan depends on the risk group: low, intermediate, or high. Most children and teens with newly diagnosed Hodgkin lymphoma can be cured.

Non-Hodgkin lymphoma is not one disease. It is a group of several different lymphomas. The most common types in children are Burkitt lymphoma, diffuse large B-cell lymphoma, lymphoblastic lymphoma, and anaplastic large cell lymphoma. These types can grow fast. Treatment usually starts soon after diagnosis. Non-Hodgkin lymphoma can spread to the bone marrow. It can also spread to the fluid around the brain and spinal cord. So doctors test both a bone marrow sample and a spinal fluid sample.

A biopsy confirms the diagnosis. Doctors remove tissue from an enlarged lymph node or other affected area. They study it under a microscope. They also run extra lab tests, including tests for proteins on the cell surface. These tests pin down the exact type. Imaging tests — CT, PET, and MRI scans — show how far the lymphoma has spread. So do the bone marrow and spinal fluid tests. Together, this sets the stage, from I (one area) to IV (widespread, including bone marrow, brain, or spinal fluid).

Chemotherapy is the backbone of treatment for both types. For non-Hodgkin lymphoma, doctors choose the drug combination based on the exact subtype and stage. Fast-growing types like Burkitt lymphoma need intense treatment. But that treatment is often shorter than you might expect. For Hodgkin lymphoma, chemotherapy alone often cures earlier-stage disease. Radiation gets added for some children, based on how the cancer responds early on.

Other treatments are used in some cases. These include targeted therapy and immunotherapy. For lymphoma that returns after treatment, doctors may use high-dose chemotherapy with a stem cell transplant. CAR T-cell therapy is another option for some relapsed cases. It reprograms a child's own immune cells to attack the cancer.

Fast-growing lymphomas like Burkitt lymphoma respond to chemotherapy very quickly. Many cancer cells can die all at once. That releases their contents into the blood. It can throw off the body's normal chemical balance. Doctors call this tumor lysis syndrome. It is a known risk in the first days of treatment. That is why children starting treatment for a fast-growing lymphoma are often admitted to the hospital. They get extra fluids and close blood tests to catch any problem early.

• Call 911 or go to an emergency department if your child has trouble breathing, noisy or fast breathing, a swollen or purple face and neck, or will only breathe comfortably sitting up. A lymphoma mass in the chest can squeeze the airway or the big veins, and that needs treating within hours.
• Call your child's care team immediately, day or night, if your child's temperature reaches 100.5°F — 38 °C is 100.4 °F; act at 100.4 °F — or higher while on chemotherapy, as NCI describes for children with low blood counts. Fever during treatment is an emergency, not something to leave until morning. If you cannot reach the team quickly, take your child to an emergency department and say at the desk that they are having chemotherapy.
• Call 911 or go to an emergency department if your child is very drowsy, confused, or hard to rouse, is passing very little urine, or has a seizure. In the first days of treatment for a fast-growing lymphoma, these can be signs of tumor lysis syndrome.
• Call your care team the same day if your child has sudden severe pain, a lymph node that is visibly growing day by day, or new drenching night sweats.

Ask which type of lymphoma your child has, and what stage. Ask whether a bone marrow or spinal fluid test was part of the workup, and what it showed. Ask what the full treatment plan looks like. Ask whether a clinical trial is open through the Children's Oncology Group. Ask what side effects to watch for at home, and who to call after hours.

• National Cancer Institute — Childhood Hodgkin Lymphoma Treatment (PDQ).
• National Cancer Institute — Childhood Non-Hodgkin Lymphoma Treatment (PDQ).
• NCBI Bookshelf (StatPearls) — Tumor Lysis Syndrome.