Non-Hodgkin Lymphoma  (NHL)

What is non-Hodgkin lymphoma?

Non-Hodgkin lymphoma (NHL) is a type of cancer that grows in the white blood cells of the lymph system, called lymphocytes. The lymph system is a part of the immune system, which normally helps fight infection and disease in the body. The other main type of lymphoma is Hodgkin lymphoma.

Non-Hodgkin lymphoma can grow in lymph tissue anywhere in the body, including the lymph nodes, bone marrow, spleen, tonsils and thymus.

While NHL is more common in adults, children can also get it. There are three main kinds of NHL that affect children:

• Mature B-cell non-Hodgkin lymphoma: This group of lymphomas includes the most common type of NHL, diffuse large B-cell lymphoma. They can grow and spread quickly.
• Lymphoblastic lymphoma: This type usually forms in the space between the lungs (called the mediastinum). It can also spread to other parts of the body.
• Anaplastic large cell lymphoma: This kind of NHL most often forms in the lymph nodes, bone or skin, but may also grow in the gastrointestinal tract, lungs or muscle.

There are several other types of NHL, but these are not very common in children.

What are the symptoms of non-Hodgkin lymphoma?

The symptoms of NHL can vary depending on what type of NHL your child has, and in which part of the body it forms. Some common symptoms in children may include:

• Swollen lymph nodes in the underarm, neck, groin or stomach
• Coughing or wheezing
• Shortness of breath
• Trouble swallowing
• Swelling or pain in the belly
• Coughing
• Unexplained weight loss
• Night sweats
• Fever

What causes non-Hodgkin lymphoma?

Experts do not know exactly what causes Hodgkin lymphoma in children, but there are some factors that may increase a child’s risk. These include:

• Having a condition that causes a weakened immune system
• HIV infection
• Having had the Epstein-Barr virus (mononucleosis)
• Taking immunosuppressive drugs after an organ transplant
• Having been treated with radiation therapy or chemotherapy for other types of cancer

How is Hodgkin lymphoma treated?

Treatment options for NHL will depend on the specific type of NHL your child has, where it is located and whether it has spread to other parts of the body. Your care team at Arkansas Children’s are experienced in treating all types of NHL and we’ll work with your family to come up with the best treatment plan for your child’s specific type of NHL and symptoms. Treatment options may include:  

• Surgery to remove the cancer. This may be an option if the NHL has not spread. Surgery may also be used along with other treatments.
• Chemotherapy to kill the cancer cells. The chemotherapy may be taken by mouth or injected into the bloodstream. It can be used alone or with other treatments.
• Radiation therapy, which uses high-energy x-rays to kill cancer cells or stop the cancer from growing.
• Targeted drug therapy attacks specific cancer cells directly. One type of targeted therapy is monoclonal antibody therapy. Monoclonal antibodies are man-made antibodies that target specific cancer cells. There are several used to treat NHL. 
• Immunotherapy is a newer type of treatment that uses your child’s immune system to help fight the cancer. One type is CAR T-cell therapy. In this treatment, your child’s T cells (a type of cell in the immune system) are changed so they attack specific proteins on the cancer cells.
• Bone marrow transplant (BMT) is also called a stem cell transplant and uses high doses of chemotherapy to damage the bone marrow. Then healthy stem cells from your child’s bone marrow, or from a donor, are placed back into the blood. This treatment may be used if other types of treatment don’t work of if your child’s cancer comes back after treatment.
• Clinical trials test new types of cancer treatments. Ask your child’s doctor if they are eligible for any clinical trials to treat NHL.