Lymphoma in Children

What is lymphoma?

Lymphoma is any cancer that starts in the lymphatic system. The lymphatic system is a network of organs and vessels that moves a clear liquid called lymph around the body. This network is a key part of the body’s immune system. The lymphatic system helps filter out dead cells and other debris from the bloodstream. It also helps protect the body against germs, including bacteria and viruses.

Lymphomas we treat

St. Jude Children’s Research Hospital treats children with all types of lymphomas, including difficult-to-treat cases. The two main types of lymphoma include:

How does lymphoma affect the body?

The lymphatic system has many parts. These include the:

  • Spleen (in the belly)
  • Tonsils and adenoids (in the neck)
  • Thymus (in the chest behind the breastbone)
  • Lymph nodes (“glands”) in the neck, underarms, stomach and groin

Lymph vessels connect these organs and nodes together.

Lymphoma can start in any part of the lymphatic system. Once cells in the lymphatic system, called lymphocytes, become abnormal, the cells often grow quickly, then divide in half to make more cells. Over time, the lymphoma cells in the lymphatic system can travel all over the body. These cells prevent healthy cells near them from working normally and make it difficult for the immune system to work properly. These cells also use nutrients and energy, causing healthy cells to starve.

Is lymphoma hereditary?

Researchers have not found a clear pattern for lymphoma running in families. For Hodgkin lymphoma, having a brother or sister with the disease increases the risk of getting it. The risk is also high for an identical twin of a person with Hodgkin lymphoma. But most people with Hodgkin lymphoma do not have a family history of it.

For non-Hodgkin lymphoma, there may be a small increase in risk if a parent, brother or sister has the disease. Scientists are still studying this question, but most people with non-Hodgkin lymphoma do not have a family history of it.

How common is lymphoma?

Childhood lymphoma is rare. Around 8% of cancers that affect children and teens are lymphoma; 5% of children with cancer will have non-Hodgkin lymphoma, while 3% will have Hodgkin lymphoma.

Non-Hodgkin lymphomas are more common in children under the age of 14. But once children reach 19, the risk of developing non-Hodgkin and Hodgkin lymphoma becomes more equal. Hodgkin lymphoma is most commonly diagnosed in early adulthood. It is uncommon for children younger than 3 to be diagnosed with lymphoma.

Boys are two-to three-times more likely to develop non-Hodgkin lymphoma than girls. It is also more common in Caucasians than in African-Americans.

What are the symptoms of lymphoma?

Not all children or adolescents with lymphoma have symptoms. Those who do may only have a few or many symptoms. Common symptoms of lymphoma include:

  • Lumps in the neck, underarm, stomach, testicles or groin (sometimes called “swollen glands”)
  • Fever
  • Night sweats
  • Feeling tired
  • Weight loss (without a good reason)
  • Itchy skin
  • Feeling out of breath
  • Cough
  • Chest pain
  • Poor appetite
  • Swollen belly

These symptoms can also be caused by conditions other than lymphoma. Talk to your doctor if your child has any of these issues.

How is lymphoma diagnosed?

If your child has symptoms of lymphoma, the doctor will do a full physical exam. A biopsy may be needed for diagnosis. During a biopsy, some or all of an abnormal lymph node is taken out and looked at in the lab under a microscope. It is possible that the doctor will use a hollow needle instead. The needle is put into the abnormal lymph node and a little bit of tissue is taken into the needle.

During this test, children are often put to sleep with general anesthesia. Sometimes, only numbing medicine on the skin is used (local anesthesia). In that case, children may also get medicines to make them feel calm and sleepy (sedation).

How is lymphoma treated?

Different types of treatment may be used for children with lymphoma:

  • Chemotherapy (“chemo”)—uses powerful medicines to kill cancer cells or stop them from growing. Chemo is given to children with either type of lymphoma (Hodgkin or non-Hodgkin).
    • Chemo may be injected into the bloodstream, so that it can travel through the body.
    • Some chemo may be given by mouth.
    • Combination therapy uses more than one type of chemo at a time.
  • Radiation therapy—uses high-energy X-rays or other types of radiation to kill cancer cells or stop them from growing. This is only used for some children who have Hodgkin lymphoma that has not spread through the body.
  • Targeted therapy—uses medicines or other treatments to target and attack specific cancer cells without harming healthy cells. Some targeted therapies can be used for children with Hodgkin lymphoma.

What are the survival rates for lymphoma?

Different forms of childhood lymphoma have different survival rates.

  • Hodgkin lymphoma—The survival rate among children who are diagnosed and treated early is between 90% and 95% by five years after diagnosis. For children whose disease has spread through the body by the time they are diagnosed and treated, the survival rate is about 90% after five years.
  • Non-Hodgkin lymphoma—After treatment, about 80% of children are disease-free five years after diagnosis. If the cancer is caught early and has not spread through the body, about 90% of children who are treated are disease-free five years after diagnosis.

Why choose St. Jude for your child’s lymphoma treatment?

  • St. Jude is the only National Cancer Institute–designated Comprehensive Cancer Center devoted solely to children.
  • St. Jude has created more clinical trials for cancer than any other children’s hospital in the United States.
  • The nurse-to-patient ratio at St. Jude is unmatched—averaging 1:3 in hematology and oncology, and 1:1 in the Intensive Care Unit.
  • Patients have access to large clinical teams who are experts in Hodgkin lymphoma and non-Hodgkin lymphoma.
  • St. Jude researchers are studying ways to reduce the amount of treatment for lymphoma while keeping cure rates the same. Reducing treatment should lessen the long-term side effects of chemotherapy.
  • St. Jude is headquarters to the Pediatric Hodgkin Lymphoma Consortium. The consortium brings together many hospitals to try to develop new treatment strategies for children with Hodgkin lymphoma. The consortium is led by St. Jude and includes Stanford University School of Medicine and Lucile Packard Children’s Hospital at Stanford, Dana-Farber Cancer Institute and Boston Children’s Hospital, Massachusetts General Hospital, and Maine Medical Center.

Associated Clinical Trials

ALLR18: Therapy for Pediatric Relapsed or Refractory Precursor B-Cell Acute Lymphoblastic Leukemia and Lymphoma

A Phase II Study of Therapy for Pediatric Relapsed or Refractory Precursor B-Cell Acute Lymphoblastic Leukemia and Lymphoma

Diseases Treated:

Relapsed or refractory precursor B-cell acute lymphoblastic leukemia and lymphoma

Eligibility:

  • B-cell acute lymphoblastic leukemia or lymphoblastic lymphoma that has:
    • Come back after treatment the first time
    • Did not respond to treatment the first time
  • Less than 22 years of age
  • Does not have HIV or hepatitis B infection
View Trial

ALTE1631: Web-based Exercise Study for Children and Adolescents with Acute Lymphoblastic Leukemia

Web-based Physical Activity Intervention among Children and Adolescents with Acute Lymphoblastic Leukemia

Diseases Treated:

Acute lymphoblastic leukemia

Eligibility:

This is a non-therapeutic clinical trial open to patients receiving treatment at a Children’s Oncology Group (COG)-affiliated institution.

  • At least 8 years old and younger than 16 years old
  • Newly diagnosed acute lymphoblastic leukemia (ALL), in first remission
  • Completed chemotherapy within past 90 days
  • Performance status corresponding to ECOG scores of 0, 1, 2
  • Fewer than 420 minutes of moderate to vigorous physical activity (MVPA) over the last week
  • Access to smart phone (Android 4.3 or later, iOS 7.1 or later or computer with connection to the internet)
  • Able to write and read English (patient and at least one parent/guardian)
  • Not pregnant
View Trial

APNEA: Sleep Apnea in Hodgkin Lymphoma Survivors Treated with Radiation to the Chest

Obstructive Sleep Apnea in Survivors of Hodgkin Lymphoma Treated with Thoracic Radiation

Diseases Treated:

Hodgkin lymphoma

Eligibility:

This is a non-therapeutic clinical trial that is only open to former St. Jude patients, their family members and friends.

Hodgkin lymphoma survivor

  • Current St. Jude LIFE participant, treated with thoracic radiation for Hodgkin lymphoma
  • At least 18 years old
  • At least 5 years from original diagnosis

Comparison group

  • Sibling, parent, relative or friend of a current or former St. Jude patient
  • At least 18 years old
View Trial

DSCOG: Learning, Behavior and Social Skills in Survivors of Childhood Leukemia with Down syndrome

Neurocognitive and Psychosocial Outcomes in Survivors of Childhood Leukemia with Down syndrome

Diseases Treated:

Leukemia

Eligibility:

This is a non-therapeutic clinical trial that is open only to patients who were treated at St. Jude Children’s Research Hospital since 1980 and are currently followed at the hospital.

  • St. Jude Children’s Research Hospital patient with acute leukemia (i.e., ALL or AML)
  • Trisomy 21 Down syndrome diagnosis
  • Completed all cancer therapy at St. Jude since 1980 and at least six months prior to study visit
  • English as the primary language
View Trial

EBV201: Immunotherapy for Epstein-Barr Virus-Associated Cancers

Study of Allogeneic Epstein-Barr Virus Cytotoxic T Lymphocytes (EBV-CTLs) in EBV-Associated Viremia or Malignancies

Diseases Treated:

Lymphoma

Eligibility:

  • Epstein-Barr Virus (EBV) lymphoma or EBV-associated lymphoproliferative disorder
  • Primary or acquired immunodeficiency
  • Appropriate HLA partially-matched and restricted EBV-Cytotoxic T Lymphocytes (EBV-CTLs)
  • No other satisfactory therapies available to treat EBV disease
View Trial

FAMHL: Genetic Study of Families with Hodgkin Lymphoma

Genetic Study of Families with High Frequency of Hodgkin Lymphoma

Diseases Treated:

Hodgkin lymphoma

Eligibility:

  • 21 years of age or younger
  • Patient has a parent, sister, brother or child who also has Hodgkin lymphoma
  • Patient’s other family members who agree to participate

 

View Trial

HAPNK1: Blood and Marrow Transplant (BMT) for Children with Leukemia/Lymphoma

Haploidentical Donor Hematopoietic Progenitor Cell and Natural Killer Cell Transplantation with a TLI-Based Conditioning Regimen in Patients with Hematologic Malignancies

Diseases Treated:

Leukemia and lymphoma

Eligibility:

  • 21 years and younger
  • Does not have a suitable HLA-matched sibling donor or volunteer HLA-matched unrelated donor or is not a candidate for conventional matched donor transplant due to refractory disease
  • Has a suitable single haplotype-matched family member donor
  • High-risk hematologic malignancy, including certain diagnoses of:
    • Acute lymphoblastic leukemia (ALL)
    • Acute myeloid leukemia (AML)
    • Chronic myelogenous leukemia (CML)
    • Myelodysplastic syndrome (MDS)
    • Hodgkin lymphoma
    • Non-Hodgkin lymphoma
View Trial

HLHR13: Brentuximab Vedotin, Combination Chemotherapy, and Radiation Therapy in Treating Younger Patients with Stage IIB-IVB Hodgkin Lymphoma

Adcetris® (Brentuximab Vedotin) Substituting Vincristine in the OEPA/COPDac Regimen [Treatment Group 3 (TG3) of Euro-Net C1] With Involved Node Radiation Therapy for High-Risk Pediatric Hodgkin Lymphoma (HL)

Diseases Treated:

High-risk Hodgkin lymphoma

Eligibility:

  • Has high-risk Hodgkin lymphoma
  • 18 years of age or younger
  • Has not received previous treatment for Hodgkin lymphoma
View Trial

HOD08: Combination Chemotherapy with or without Radiation Therapy in Treating Young Patients with Favorable-Risk Hodgkin Lymphoma

Reduced Duration Stanford V Chemotherapy With or Without Low-Dose Tailored-Field Radiation Therapy for Favorable Risk Pediatric Hodgkin Lymphoma

Diseases Treated:

Hodgkin lymphoma

Eligibility:

  • Diagnosis of early-stage Hodgkin lymphoma 
  • Hodgkin lymphoma that has not been previously treated
  • 21 years of age or younger
View Trial

HODLP: First International Inter-Group Study for Nodular Lymphocyte Predominant Hodgkin Lymphoma in Children and Adolescents

Surgery Alone, Surgery With Cyclophosphamide, Vinblastine, and Prednisolone (CVP), or CVP Alone in Treating Young Patients With Stage IA or Stage IIA Nodular Lymphocyte-Predominant Hodgkin Lymphoma

Diseases Treated:

Lymphocyte predominant Hodgkin lymphoma 

Eligibility:

  • Diagnosis of early-stage lymphocyte-predominant Hodgkin lymphoma (LPHL)
  • LPHL that has not been previously treated with chemotherapy or radiation therapy
  • 18 years of age or younger

 

View Trial

LDTAM: Low-Dose Tamoxifen Citrate in Reducing Breast Cancer Risk in Radiation-Induced Cancer Survivors

Low-dose Tamoxifen in Hodgkin Lymphoma Survivors for Breast Cancer Risk Reduction: A Phase IIB Randomized Placebo-Controlled Trial

Diseases Treated:

For survivors of Hodgkin lymphoma

Eligibility:

  • Females, 25 years of age or older.
  • Participant does not plan to become pregnant in the next 2 years and is not currently breast feeding.
View Trial

LiSTENING: Learning in Story: Elicited Narrative Informs Navigating Genetics

Eligibility:

This is a non-therapeutic clinical trial open to St. Jude patients only.

Participants have been pre-identified by the primary care team as an English-speaking, four-member family unit diagnosed with TP53 mutation.

View Trial

M16-106: Combination Chemotherapy for Relapsed Acute Lymphoblastic Leukemia

Phase I Study of Venetoclax with Navitoclax and Chemotherapy for Relapsed Acute Lymphoblastic Leukemia

Diseases Treated:

Acute lymphoblastic leukemia

Eligibility:

  • Acute lymphoblastic leukemia (ALL) that has not responded to treatment or has come back after treatment
  • Between 4 and 45 years old
  • Weigh at least 20 kg (44 lbs)
  • Able to swallow pills

 

 

View Trial

NCBP01: Safety Study of Unlicensed, Investigational Cord Blood Units Manufactured by the NCBP for Unrelated Transplantation

A Multicenter Safety Study of Unlicensed, Investigational Cryopreserved Cord Blood Units (CBUs) manufactured by the National Cord Blood Program (NCBP) and provided for Unrelated Hematopoietic Stem Cell Transplantation of Pediatric and Adult Patients

Diseases Treated:

Leukemia and other blood diseases

Eligibility:

This is a non-therapeutic clinical trial that is only open to St. Jude patients.

  • Participant is receiving an allogeneic hematopoietic stem cell (HSC) transplant at St. Jude Children's Research Hospital using an unlicensed cord blood unit (CBU).
  • Participant may be of any age and either gender.
  • Participant has a medical disorder affecting the hematopoietic system that is inherited, acquired, or a result from myeloablative treatment.
  • Participant is receiving HPC-CORD BLOOD product manufactured by NCBP (at least one, if the graft contains more than one units).
View Trial

PANAML: Panobinostat, Fludarabine and Cytarabine in Patients with AML or MDS

A Phase I and Dose Expansion Cohort Study of Panobinostat in Combination with Fludarabine and Cytarabine in Pediatric Patients with Refractory or Relapsed Acute Myeloid Leukemia or Myelodysplastic Syndrome

Diseases Treated:

Acute myeloid leukemia (AML), myelodysplastic syndrome (MDS)

Eligibility:

  • Diagnosis of AML or MDS that has come back or did not respond to chemotherapy
  • 21 years of age or younger at time of enrollment
  • Able to swallow capsules
  • Recovered from side effects of previous cancer therapy
View Trial

REF2HCT: Haploidentical Bone Marrow Transplant for Leukemia and Lymphoma

Provision of TCRγδ T Cells and Memory T Cells plus Selected Use of Blinatumomab in Naïve T-cell Depleted Haploidentical Donor Hematopoietic Cell Transplantation for Hematologic Malignancies Relapsed or Refractory despite Prior Transplantation

Diseases Treated:

Eligibility:

  • 21 years old and younger
  • Diagnosed with one of the following that has come back or did not improve after bone marrow transplant
    • Acute lymphoblastic leukemia (ALL)
    • Acute myeloid leukemia
    • Myeloid sarcoma
    • Chronic myeloid leukemia (CML)
    • Juvenile myelomonocytic leukemia (JMML)
    • Myelodysplastic syndrome (MDS)
    • Non-Hodgkin lymphoma (NHL)
  • Has a family member who is a suitable stem cell donor
View Trial

SELHEM: Selinexor With Fludarabine and Cytarabine for Treatment of Refractory or Relapsed Leukemia or Myelodysplastic Syndrome

Phase I/II Study of the Selective Inhibitor of Nuclear Export Selinexor (KPT-330) in Combination with Fludarabine and Cytarabine in Patients with Refractory or Relapsed Leukemia or Myelodysplastic Syndrome

Diseases Treated:

Relapsed or refractory leukemia or hematologic malignancies

Eligibility:

(Phase II)

  • 21 years of age or younger
  • Acute myeloid leukemia (AML)
  • No history of HIV infection
View Trial

SJBC3: Mature B-cell Lymphoma and Leukemia Study III

Risk-Adapted Therapy in Treating Young Patients with Mature B-Cell Lymphoma or Leukemia

Diseases Treated:

Leukemia and lymphoma

Eligibility:

  • 21 years of age or younger
  • Newly diagnosed mature B-cell non-Hodgkin lymphoma and leukemia
  • No previous treatment (no more than 72 hours of steroids, one intrathecal chemotherapy treatment, and/or emergency radiation)
View Trial

TINI: Total Therapy for Infants With Acute Lymphoblastic Leukemia (ALL)

Diseases Treated:

Acute lymphoblastic leukemia (ALL)

Eligibility:

  • Newly diagnosed ALL
  • 1 year of age or younger at the time of diagnosis
  • Has not had any — or has had limited — prior therapy
  • Does not have mature B-cell ALL, acute myeloid leukemia (AML) or Down syndrome
View Trial

TOT17: Total Therapy for Children with Acute Lymphoblastic Leukemia and Lymphoma

Total Therapy Study 17 for Newly Diagnosed Patients with Acute Lymphoblastic Leukemia and Lymphoma

Diseases Treated:

Leukemia and lymphoma

Eligibility:

  • Diagnosis of B-cell or T-cell acute lymphoblastic leukemia (ALL) or acute lymphoblastic lymphoma (LLy)
  • 1 to 18 years old
  • No prior therapy or limited prior therapy
View Trial

VENAML: Chemotherapy Combined with Venetoclax in Children with Refractory or Relapsed Acute Myeloid Leukemia

A Phase I and Expansion Cohort Study of Venetoclax in Combination with Chemotherapy in Pediatric Patients with Refractory or Relapsed Acute Myeloid Leukemia

Diseases Treated:

Acute myeloid leukemia (AML), acute undifferentiated leukemia, mixed phenotype acute leukemia

Eligibility:

  • Diagnosis of relapsed or refractory acute myeloid leukemia (AML), acute undifferentiated leukemia or mixed phenotype acute leukemia 
  • At least 2 years old and younger than 22 years old
  • Able to swallow pills
  • Recovered from acute effects of prior therapy and no evidence of graft-versus-host disease (GVHD)
  • Adequate liver, kidney and heart functions
View Trial

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