Pediatric non-Hodgkin’s lymphoma (NHL) is a type of cancer that may affect children. It occurs when cells in the immune system divide uncontrollably. Symptoms can depend on where the cancer develops.

There are different types of NHL in children. Chemotherapy is the primary treatment, but other treatments may sometimes be beneficial.

Read on to learn more about pediatric NHL. This article examines types of NHL, causes, symptoms, treatment options, and more.

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The three main types of NHL that may develop in children include:

  • aggressive mature B-cell non-Hodgkin lymphoma (B-cell NHL)
  • lymphoblastic lymphoma
  • anaplastic large-cell lymphoma

Learn more about NHL.

Aggressive mature B-cell NHL

Aggressive mature B-cell NHL is a cancer of the cells that create antibodies, the immune cells that counter infections. Most lymphomas start in these B cells. Three different forms of aggressive B-cell NHL develop in children:

  • Diffuse large B-cell lymphoma: This is the most common type of NHL but occurs more in teenagers than younger children. It is an aggressive, fast-growing cancer of the B-cells that develops quickly in the lymph nodes. These are bean-shaped structures that store B-cells and T-cells and filter lymph fluid. Diffuse large B-cell lymphoma also often affects the liver, spleen, bone marrow, and other organs.
  • Burkitt lymphoma or leukemia: This aggressive disease is most common in children and young adults. It may start in the lymph nodes as lymphoma before spreading to the blood and bone marrow. It can develop in the abdomen, bones, bone marrow, skin, head and neck, or central nervous system (CNS).
  • Primary mediastinal B-cell lymphoma: This develops in B-cells in the area between the lungs, known as the mediastinum. This can spread to the lungs and the sac around the heart, or pericardium, as well as organs further away, such as the kidneys. This type is more common in older teens than younger children.

Learn more B-cell NHL.

Lymphoblastic lymphoma

Lymphoblastic lymphoma largely affects T-cell lymphocytes, a type of cell that works with B-cells to produce antibodies. It usually develops in the mediastinum, causing difficulty breathing and swallowing and head and neck swelling.

Learn more about lymphoblastic lymphoma.

Anaplastic large cell lymphoma

Anaplastic large cell lymphoma usually affects T-cell lymphocytes in the:

  • lymph nodes
  • skin
  • bones
  • gut
  • lungs and their covering tissue
  • muscle

T cells in people who develop this type have a receptor on the surface called CD30. This shows in NHL tests. A change in a gene called ALK also points to anaplastic large-cell lymphoma.

Learn more about anaplastic large cell lymphoma.

Rare types

Less commonly, other types of NHL that can develop in children and teenagers include:

  • pediatric-type follicular lymphoma, a slow-growing type that usually stays in one place, often the tonsils or lymph nodes in the neck
  • marginal zone lymphoma, which grows slowly in or just outside the lymph nodes
  • peripheral T-cell lymphoma, an aggressive type that grows in mature T lymphocytes
  • cutaneous T-cell lymphoma, which develops on the skin and is much more common in teens and young adults than children
  • primary CNS lymphoma, an extremely rare type in children

Learn more about the types of NHL.

The symptoms of NHL usually depend on the type, aggressiveness, and the location where it develops.

Common symptoms of pediatric NHL include:

Many NHL symptoms may also occur due to other conditions, so it is best to check with a healthcare professional if these develop in a child.

Learn more about the symptoms of NHL.

The exact cause of pediatric NHL is unclear.

However, several factors may increase the likelihood of the condition:

  • Older children may have a higher NHL risk than younger ones.
  • Children assigned male at birth get NHL more often than children assigned female at birth.
  • NHL is more common in white children than in Black children.

Several health conditions may also increase the risk of NHL. These include:

  • weakened immune system
  • congenital health problems, such as Wiskott-Aldrich syndrome, Nijmegen syndrome, and ataxia-telangiectasia
  • children taking drugs to suppress the immune system after organ transplants
  • exposure to radiation, either from atomic bomb exposure, nuclear reactor accidents, or radiation therapy for other cancers

NHL may also have a link to chronic Epstein-Barr virus (EBV) and malaria for children in parts of Africa where Burkitt lymphoma is common.

Learn more about Burkitt lymphoma.

To help reach an accurate diagnosis, a doctor may begin by taking a full medical history and performing a physical examination, including checking for swollen lymph nodes and asking questions about symptoms.

They may then order various tests, such as:

First, a doctor will check for swollen lymph nodes. As glands more often swell due to infection, the doctor may prescribe antibiotics and wait several weeks to rule out an infection before removing tissue from a lymph node.

A biopsy is the only way to confirm NHL.

After diagnosis, imaging tests can help a doctor check whether NHL has spread, and help determine the right treatment. Possible imaging tests include:

Blood tests can also check levels of certain cells in the blood that suggest lymphoma has moved to the bone marrow. They can also help show kidney or liver function.

Learn more about blood tests and results for NHL.

Chemotherapy is the main treatment for pediatric NHL. Different types of NHL require different doses, schedules, and recovery periods.

The particular drug also depends on the stage of the cancer. Common examples include:

  • cyclophosphamide
  • cytarabine
  • dexamethasone
  • doxorubicin
  • etoposide
  • ifosfamide
  • l-asparaginase
  • methotrexate
  • prednisone
  • vincristine
  • 6-mercaptopurine

A cancer care team usually administers chemotherapy medications through an IV drip. Most children can usually return home on the same day as treatment, but some children may need to stay in the hospital during the earlier stages of treatment.

Learn more about chemotherapy medications.

Other treatments

Other treatments for pediatric NHL include:

  • surgery
  • monoclonal antibody therapy
  • antibody-drug conjugates (ADCs)
  • ALK inhibitor treatments

The child’s doctor can provide more information about recommended treatments and explain what they involve.

Learn more about treatments for NHL.

In the United States, around 800 children and teenagers receive an NHL diagnosis each year. It is around 2 to 3 times more common in boys than girls.

NHL is rare in children aged 5 years or younger.

Learn more about diagnosing lymphoma.

Here are some frequently asked questions about pediatric NHL.

How do you know if your child has NHL?

The most common symptoms of NHL are painless swollen lymph nodes in the throat, neck, armpit, or groin. Other symptoms may depend on where the condition develops. As a lot of symptoms can develop due to other conditions, it is important to contact a doctor for an accurate diagnosis.

What is the most common NHL in children?

Burkitt lymphoma is the most common type of NHL in children in the United States. It accounts for 40% of pediatric NHL. It typically develops between the ages of 5 and 14 years, and is more common in boys.

What is the survival rate for children with NHL?

The survival rate for pediatric NHL depends on many factors, including the type of cancer, how far it has spread, and whether treatment is effective.

Most types of pediatric NHL have a long-term survival rate of more than 90% at stages I and II. The long-term survival rate for advanced-stage pediatric NHL is between 60% and over 80%.

The survival rate refers to the proportion of people who are still alive for a certain time after receiving a particular diagnosis. For example, a 5-year survival rate of 50% means that 50%, or half, of the people are still alive 5 years after receiving the diagnosis.

It is important to remember that these figures are estimates and are based on the results of previous studies or treatments. A person can consult a healthcare professional to discuss their outlook.

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There are several types of pediatric NHL, including Burkitt lymphoma, lymphoblastic lymphoma, and aggressive mature B-cell NHL.

Symptoms often start with swollen lymph nodes. NHL can also cause breathing problems, unexplained weight loss, night sweats, and other symptoms, depending on the location and type of cancer.

A biopsy is necessary to confirm NHL. Imaging and blood tests can help doctors understand the type and extent of NHL. Treatment typically involves chemotherapy, but doctors may also recommend other treatments.