A persistent lump, unexplained fever or unusual tiredness can be concerning for parents. Most of these symptoms are caused by common childhood illnesses, but when they persist, recur or appear alongside other changes, medical advice is important.
“Childhood Hodgkin lymphoma has among the highest cure rates in paediatric oncology, with five-year relative survival generally around 90% or higher”
Lymphomas are cancers of lymphocytes, a type of white blood cell. They usually arise in lymphoid tissues but can occur in other organs. It can affect children and adults, but the disease is not the same in both age groups.
Understanding these differences has helped doctors improve treatment while reducing its long-term effects.
Childhood lymphoma is not one disease
Lymphoma includes many different subtypes. In children, it is more likely to be one of several fast-growing forms of non-Hodgkin lymphoma, including lymphoblastic lymphoma, Burkitt lymphoma and anaplastic large-cell lymphoma. Hodgkin lymphoma is also important, particularly among teenagers and young adults.
Adults are more likely to develop a broader range of lymphomas, including slower-growing types such as follicular lymphoma, which is uncommon in children.
“Children are not simply small adults,” explains Dr Mohd Haris Fadzillah Bin Abdul Rahman, Consultant Physician and Haematologist at Subang Jaya Medical Centre (SJMC) and President of the Malaysian Society of Haematology.
“The biology of lymphoma can differ across age groups, including the genetic changes that drive the disease. Identifying the precise subtype is therefore essential before treatment begins.”
Possible warning signs
Lymphoma may cause:
- A persistent or enlarging, usually painless lump in the neck, armpit or groin
- Ongoing or unexplained fever
- Night sweats
- Unintentional weight loss
- Persistent tiredness or pallor
- Recurrent infections
- Unexplained bruising or bleeding
- Abdominal swelling or discomfort
- A persistent cough or breathing difficulty.
These symptoms are not specific to lymphoma. Enlarged lymph nodes, for example, are common during infections. However, a child should be assessed if a lump does not settle, continues to grow or occurs with other unexplained symptoms. Breathing difficulty, severe weakness or significant bleeding requires urgent medical attention.
Treatment is increasingly tailored to the child
Chemotherapy remains central to the treatment of many childhood lymphomas. Fast-growing lymphomas can be particularly sensitive to chemotherapy, allowing doctors to achieve high cure rates.
However, chemotherapy is now part of a wider treatment toolkit. Depending on the lymphoma subtype and the child’s response, treatment may include:
- Monoclonal antibodies, such as rituximab, which targets CD20 on many B-cell lymphomas
- Targeted medicines, which block signals or processes that lymphoma cells rely on
- Immunotherapy, including bispecific antibodies that bring lymphoma cells into contact with immune cells
- Stem cell transplantation, which may be considered when lymphoma returns or is difficult to treat
- CAR T-cell therapy, in which a child’s T-cells are modified to recognise and attack particular cancer cells.
“These treatments do not simply replace chemotherapy,” says Dr Haris. “They give doctors more options to combine according to the lymphoma and the individual patient.”
Treatment decisions are based on the precise diagnosis, disease stage, molecular findings, the child’s health and response to therapy. Newer treatments can cause serious side effects and are not suitable for every child.
Protecting long-term health matters
For children, successful treatment is only the beginning. Because they may live for many decades after cancer treatment, doctors must also consider possible long-term effects on the heart, lungs, fertility, growth, learning and emotional wellbeing.
“Survival alone is no longer enough,” says Dr Kogilavani Gunasagaran, Consultant Paediatrician and Paediatric Haematologist and Oncologist at SJMC. “The goal is to cure the lymphoma while minimising the long-term impact of treatment.”
Targeted treatments and immunotherapies may reduce the need for conventional chemotherapy in selected patients, but this remains an active area of research.
The first priority is always to maintain the best possible chance of cure.
What is the outlook?
The prognosis (outcome) for many children with lymphoma is highly encouraging, although it varies according to the subtype, stage, molecular characteristics, treatment response and whether the disease returns.
Childhood Hodgkin lymphoma has among the highest cure rates in paediatric oncology, with five-year relative survival generally around 90% or higher.
Across childhood and adolescent non-Hodgkin lymphomas, five-year relative survival was approximately 90% for patients diagnosed in the United States between 2013 and 2019. These are population figures, not predictions for an individual child, and outcomes differ between subtypes and risk groups.
Progress has resulted from more accurate diagnosis, risk- and response-adapted treatment, specialist multidisciplinary care and improved management of treatment complications.
Research is now focused on using molecular testing, targeted medicines, immunotherapy, cellular therapy and sensitive monitoring to make treatment more precise.
The aim is not only to cure more children, but to help them remain healthy long after treatment ends.
Parents should seek medical advice if a child has a persistent lump, unexplained fever, night sweats, weight loss, ongoing fatigue, unusual bruising or bleeding, abdominal swelling or breathing problems. These signs usually have causes other than lymphoma, but they should not be ignored when they persist.
The medical information of this article is contributed by Dr Mohd Haris Fadzillah Bin Abdul Rahman, Consultant Physician and Haematologist at Subang Jaya Medical Centre (SJMC) and President of Malaysian Society of Haematology, and Dr Kogilavani Gunasagaran, Consultant Paediatrician and Paediatric Haematologist & Oncologist at SJMC.
