Lymphoma in children: what parents need to know

When children experience persistent symptoms like unexplained lumps, fever or extreme fatigue that continue to worsen, it is advisable for parents to seek medical attention. Lymphoma, a form of cancer affecting the lymphatic system, can occur in both adults and children; however, the forms seen in younger patients often exhibit different behaviors and necessitate distinct treatment strategies.

Dr Haris Fadzillah Abdul Rahman, a consultant physician and hematologist, notes that children are more prone to developing aggressive lymphomas such as lymphoblastic lymphoma, Burkitt lymphoma, and anaplastic large-cell lymphoma. Hodgkin lymphoma may also be diagnosed in younger patients, particularly adolescents and young adults.

Conversely, adults may experience a wider array of lymphomas, including slower-growing forms that are relatively rare in children. This distinction is crucial since lymphoma is not a singular disease; its biological makeup, genetic mutations, and progression can differ significantly, prompting doctors to first identify the specific subtype before determining the most appropriate treatment.

While chemotherapy is a primary treatment modality for many childhood lymphomas, especially given the efficacy of some fast-growing forms, it is no longer the sole recourse. Groundbreaking research into the mechanisms of lymphoma cell growth and survival has paved the way for more targeted therapies that focus on specific cancer features or enhance the immune system's ability to detect and eradicate malignant cells.

Dr Kogilavani Gunasagaran, a consultant paediatrician and paediatric hematologist, emphasizes that the ultimate objective in treating pediatric patients extends beyond mere remission. She explains that achieving remission in childhood entails considerations for the patient's well-being over the subsequent decade, 20 years, or even 50 years following treatment.

The contemporary approach strives to secure a cure while simultaneously minimizing the long-term adverse effects of treatment. Consequently, treatment options may encompass targeted therapy, immunotherapy, stem-cell or bone-marrow transplantation, and an evolving method called CAR-T cell therapy. Dr Haris Fadzillah Abdul Rahman clarifies that these newer therapies do not merely substitute chemotherapy; instead, they augment the therapeutic arsenal available to physicians.

Based on the child's particular condition and lymphoma subtype, treatment may encompass a multifaceted approach. For instance, targeted therapy seeks to neutralize specific attributes of lymphoma cells without broadly disrupting all rapidly proliferating cells. Immunotherapy operates differently by empowering the body's immune system to recognize and combat lymphoma cells.

Looking ahead, the integration of targeted therapy and immunotherapy may potentially diminish or even eliminate the need for chemotherapy in select patients. The prognosis for children diagnosed with lymphoma is generally optimistic, contingent on the specific subtype, stage, molecular attributes, treatment response, and the presence or absence of disease recurrence.

Dr Kogilavani Gunasagaran highlights that childhood Hodgkin lymphoma boasts among the highest cure rates in pediatric oncology, with approximately 90-95% of children and adolescents achieving a cure. For childhood and adolescent non-Hodgkin lymphoma, the five-year relative survival rate stood at around 90% between 2013 and 2019, although individual outcomes fluctuate based on subtypes and risk categories.

These advancements owe their existence not only to novel medications but also to refined disease classification, customized treatment protocols, and enhancements in supportive care. Looking towards the future, genomic and molecular testing, targeted therapies, immunotherapy, and cellular treatments hold the potential to render care even more personalized.

For children specifically, the ultimate aim transcends mere survival of lymphoma; it involves facilitating their transition to adulthood with the minimal long-term consequences feasible.