Lymphoma in children: what parents need to know

Persistent symptoms in children such as unexplained lumps, fever or unusual tiredness should be assessed when they do not improve. (Envato Elements pic) KUALA LUMPUR: A swollen gland, lingering fever or unusual tiredness in a child will usually have a common explanation. But when symptoms do not go away, parents may understandably begin to wonder whether something more serious is happening.

Lymphoma, a cancer of the lymphatic system, can affect both adults and children, although the types seen in younger patients often behave differently and require different approaches to treatment.

Consultant physician and haematologist Dr Haris Fadzillah Abdul Rahman said children are more likely to develop fast-growing forms of lymphoma, including lymphoblastic lymphoma, Burkitt lymphoma and anaplastic large-cell lymphoma.

Hodgkin lymphoma is also seen in younger patients, particularly adolescents and young adults.

Adults, by contrast, can develop a wider range of lymphomas, including slower-growing forms that are relatively uncommon in children.

These differences matter because lymphoma is not a single disease: its biology, genetic changes and behaviour can vary considerably, which is why doctors first need to establish the precise subtype before deciding on treatment.

Personalised treatment

While chemotherapy remains an important part of treatment for many childhood lymphomas, particularly because some fast-growing forms respond very well to it, it is no longer the only option.

Advances in understanding how lymphoma cells grow and survive have led to treatments that target particular features of the cancer or help the immune system recognise and attack it.

Consultant paediatrician and paediatric haematologist and oncologist Dr Kogilavani Gunasagaran said the goal in treating children extends well beyond getting them into remission.

“Children have a much longer life expectancy after treatment. Therefore, doctors need to consider not only curing the lymphoma today, but also the patient’s health 10, 20 or 50 years later,” she said.

“The goal is increasingly to achieve a cure while minimising the long-term impact of treatment. In paediatric oncology, survival alone is no longer enough."

Treatment options, as such, may include targeted therapy, immunotherapy, stem-cell or bone-marrow transplantation, and an emerging approach known as CAR-T cell therapy .

Dr Haris Fadzillah Abdul Rahman. “Newer treatments do not simply replace chemotherapy,” Haris pointed out. “Rather, we now have a much larger treatment toolbox.”

Depending on the child and lymphoma subtype, treatment may involve a combination of approaches.

Targeted treatment, for example, aims to attack specific features of lymphoma cells rather than broadly affecting all rapidly dividing cells.

Immunotherapy, meanwhile, works differently by helping the body’s own immune system recognise and fight lymphoma cells.

In the longer term, combinations of targeted therapy and immunotherapy may allow chemotherapy to be reduced or even avoided in selected patients.

Chances of recovery

For many children diagnosed with lymphoma, the outlook can be encouraging, although it varies according to the subtype, stage, molecular characteristics, response to treatment and whether the cancer returns.

Dr G Kogilavani. Kogilavani said childhood Hodgkin lymphoma has one of the highest cure rates in paediatric oncology, with around 90-95% of children and adolescents able to be cured.

For childhood and adolescent non-Hodgkin lymphoma, five-year relative survival was about 90% between 2013 and 2019, although outcomes vary between subtypes and risk groups.

These improvements have come not only from new medicines but also from better disease classification, more tailored treatment, and advances in supportive care.

In the future, genomic and molecular testing, targeted therapies, immunotherapy and cellular treatments may make care even more personalised.

For children in particular, the aim is no longer simply to survive lymphoma: increasingly, treatment is about helping them reach adulthood with as few long-term effects as possible.