What Are Rare Childhood Non-Hodgkin Lymphomas?
Most non-Hodgkin lymphomas (NHL) in children are fast growing, aggressive cancers. The most common non-Hodgkin lymphoma diagnoses in children are Burkitt lymphoma, diffuse large B-cell lymphoma, lymphoblastic lymphoma, and anaplastic large cell lymphoma. However, there are several slow growing B-cell lymphomas that occur in this young age group. There are also rare T-cell lymphomas that are more frequently seen in adults but occasionally occur in children.
Children and teens with rare childhood non-Hodgkin lymphoma are treated at Dana-Farber/Boston Children's Cancer and Blood Disorders Center through the Childhood Lymphoma Program in our Childhood Hematologic Malignancy Center. Dana-Farber/Boston Children's offers internationally renowned care for children with cancers of the blood and immune system.
Dana-Farber/Boston Children's also offers a wide array of support services and programs for pediatric patients and their families during and after cancer treatment.
Rare Childhood Non-Hodgkin Lymphoma Types and Treatment
Two types of indolent (or slow growing) mature B-cell lymphomas that are unique to younger patients are:
- Pediatric follicular lymphoma: This often presents as a localized enlarged lymph node, stage I or II. If this type of lymphoma is completely removed by surgery, no additional treatment may be necessary. Generally, the cure rate is excellent.
- Marginal zone lymphomas (MZL): These can occur in lymph nodes or in sites such as the gastrointestinal tract or the inner eyelids, where these tumors are referred to as mucosa-associated lymphoid tissue (MALT) lymphomas. These are slow growing tumors that may be treated with surgery, radiation therapy, the immunotherapy drug rituximab, or occasionally with antibiotics.
Rare mature T-cell lymphomas include:
- Cutaneous T-cell lymphomas: These are indolent lymphomas that involve only the skin. These diseases include mycosis fungoides and subcutaneous panniculitis-like T-cell lymphoma. There is no standard therapy for these lymphomas in children. Treatment may include steroids, retinoids, chemotherapy, or radiation therapy.
- Peripheral T-cell lymphomas: These are a collection of aggressive cancers of mature T-lymphocytes. Treatment includes chemotherapy and often stem cell transplantation, either from the patient's own bone marrow (autologous) or sometimes from another person's bone marrow (allogeneic). The Dana-Farber/Boston Children's Stem Cell Transplant Center offers autologous and allogeneic stem cell transplants and is active in researching new stem cell techniques.
Other rare non-Hodgkin lymphomas include:
- Primary central nervous system lymphoma (PCNSL): This is defined by its presence in the brain or spinal cord, and nowhere else in the body. Primary central nervous system lymphoma in children is usually of the diffuse large B-cell lymphoma type. PCNSL is more common in adults than in children but is rare in both age groups. In adults, PCNSL often occurs in patients with a weakened immune system. Treatment for primary central nervous system lymphoma requires high doses of chemotherapy that enter the central nervous system, such as high-dose methotrexate and high-dose cytarabine. Radiation therapy has been used as part of the treatment for this lymphoma in adults but may not be necessary if high dose chemotherapy is used in the treatment plan.
- Cutaneous lymphomas are lymphomas that are only present in the skin.
Learn more about childhood non-Hodgkin lymphoma, including diagnosis and treatment.
Long-term Outlook for Children with Rare Non-Hodgkin Lymphomas
Childhood cancer was once considered to be invariably fatal, but today, the majority of children diagnosed with cancer can expect to be long-term survivors.
Along with survivorship come numerous complex issues: the long-term effects of treatment and the risk of second cancers, as well as social and psychological concerns. For these reasons, survivors of childhood rare non-Hodgkin lymphoma should receive regular follow-up monitoring and care.
Since 1993, physicians, nurses, researchers, and psychologists in our pediatric cancer survivorship programs at the David B. Perini Jr. Quality of Life Clinic at Dana-Farber have helped thousands of childhood cancer survivors, treated at Dana-Farber/Boston Children's and at other hospitals in New England and elsewhere, to manage these long-term challenges of surviving cancer.
Rare Childhood Non-Hodgkin Lymphomas Treatment Team
Dana-Farber/Boston-Children's patients have access to the broadest set of pediatric hematologic and oncologic expertise available. The breadth of our expertise allows us to assemble a team of specialists to meet the specific needs of your child. See a complete list of the specialists in our Childhood Hematologic Malignancy Center.