What is lymphoma?
Lymphoma is any cancer that starts in the lymphatic system. The lymphatic system is a network of organs and vessels that moves a clear liquid called lymph around the body. This network is a key part of the body’s immune system. The lymphatic system helps filter out dead cells and other debris from the bloodstream. It also helps protect the body against germs, including bacteria and viruses.
Lymphomas we treat
St. Jude Children’s Research Hospital treats children with all types of lymphomas, including difficult-to-treat cases. The two main types of lymphoma include:
How does lymphoma affect the body?
The lymphatic system has many parts. These include the:
- Spleen (in the belly)
- Tonsils and adenoids (in the neck)
- Thymus (in the chest behind the breastbone)
- Lymph nodes (“glands”) in the neck, underarms, stomach and groin
Lymph vessels connect these organs and nodes together.
Lymphoma can start in any part of the lymphatic system. Once cells in the lymphatic system, called lymphocytes, become abnormal, the cells often grow quickly, then divide in half to make more cells. Over time, the lymphoma cells in the lymphatic system can travel all over the body. These cells prevent healthy cells near them from working normally and make it difficult for the immune system to work properly. These cells also use nutrients and energy, causing healthy cells to starve.
Is lymphoma hereditary?
Researchers have not found a clear pattern for lymphoma running in families. For Hodgkin lymphoma, having a brother or sister with the disease increases the risk of getting it. The risk is also high for an identical twin of a person with Hodgkin lymphoma. But most people with Hodgkin lymphoma do not have a family history of it.
For non-Hodgkin lymphoma, there may be a small increase in risk if a parent, brother or sister has the disease. Scientists are still studying this question, but most people with non-Hodgkin lymphoma do not have a family history of it.
How common is lymphoma?
Childhood lymphoma is rare. Around 8% of cancers that affect children and teens are lymphoma; 5% of children with cancer will have non-Hodgkin lymphoma, while 3% will have Hodgkin lymphoma.
Non-Hodgkin lymphomas are more common in children under the age of 14. But once children reach 19, the risk of developing non-Hodgkin and Hodgkin lymphoma becomes more equal. Hodgkin lymphoma is most commonly diagnosed in early adulthood. It is uncommon for children younger than 3 to be diagnosed with lymphoma.
Boys are two-to three-times more likely to develop non-Hodgkin lymphoma than girls. It is also more common in Caucasians than in African-Americans.
What are the symptoms of lymphoma?
Not all children or adolescents with lymphoma have symptoms. Those who do may only have a few or many symptoms. Common symptoms of lymphoma include:
- Lumps in the neck, underarm, stomach, testicles or groin (sometimes called “swollen glands”)
- Fever
- Night sweats
- Feeling tired
- Weight loss (without a good reason)
- Itchy skin
- Feeling out of breath
- Cough
- Chest pain
- Poor appetite
- Swollen belly
These symptoms can also be caused by conditions other than lymphoma. Talk to your doctor if your child has any of these issues.
How is lymphoma diagnosed?
If your child has symptoms of lymphoma, the doctor will do a full physical exam. A biopsy may be needed for diagnosis. During a biopsy, some or all of an abnormal lymph node is taken out and looked at in the lab under a microscope. It is possible that the doctor will use a hollow needle instead. The needle is put into the abnormal lymph node and a little bit of tissue is taken into the needle.
During this test, children are often put to sleep with general anesthesia. Sometimes, only numbing medicine on the skin is used (local anesthesia). In that case, children may also get medicines to make them feel calm and sleepy (sedation).
How is lymphoma treated?
Different types of treatment may be used for children with lymphoma:
- Chemotherapy (“chemo”)—uses powerful medicines to kill cancer cells or stop them from growing. Chemo is given to children with either type of lymphoma (Hodgkin or non-Hodgkin).
- Chemo may be injected into the bloodstream, so that it can travel through the body.
- Some chemo may be given by mouth.
- Combination therapy uses more than one type of chemo at a time.
- Radiation therapy—uses high-energy X-rays or other types of radiation to kill cancer cells or stop them from growing. This is only used for some children who have Hodgkin lymphoma that has not spread through the body.
- Targeted therapy—uses medicines or other treatments to target and attack specific cancer cells without harming healthy cells. Some targeted therapies can be used for children with Hodgkin lymphoma.
What are the survival rates for lymphoma?
Different forms of childhood lymphoma have different survival rates.
- Hodgkin lymphoma—The survival rate among children who are diagnosed and treated early is between 90% and 95% by five years after diagnosis. For children whose disease has spread through the body by the time they are diagnosed and treated, the survival rate is about 90% after five years.
- Non-Hodgkin lymphoma—After treatment, about 80% of children are disease-free five years after diagnosis. If the cancer is caught early and has not spread through the body, about 90% of children who are treated are disease-free five years after diagnosis.
Why choose St. Jude for your child’s lymphoma treatment?
- St. Jude is the only National Cancer Institute–designated Comprehensive Cancer Center devoted solely to children.
- St. Jude has created more clinical trials for cancer than any other children’s hospital in the United States.
- The nurse-to-patient ratio at St. Jude is unmatched—averaging 1:3 in hematology and oncology, and 1:1 in the Intensive Care Unit.
- Patients have access to large clinical teams who are experts in Hodgkin lymphoma and non-Hodgkin lymphoma.
- St. Jude researchers are studying ways to reduce the amount of treatment for lymphoma while keeping cure rates the same. Reducing treatment should lessen the long-term side effects of chemotherapy.
- St. Jude is headquarters to the Pediatric Hodgkin Lymphoma Consortium. The consortium brings together many hospitals to try to develop new treatment strategies for children with Hodgkin lymphoma. The consortium is led by St. Jude and includes Stanford University School of Medicine and Lucile Packard Children’s Hospital at Stanford, Dana-Farber Cancer Institute and Boston Children’s Hospital, Massachusetts General Hospital, and Maine Medical Center.
Associated Clinical Trials
ALTE1631: Web-based Exercise Study for Children and Adolescents with Cancer
Web-based Physical Activity Intervention among Children and Adolescents with Cancer
Diseases Treated:
leukemia, solid tumor, brain tumor, lymphoma, carcinoma
Eligibility:
This is a non-therapeutic clinical trial open to patients receiving treatment at a Children’s Oncology Group (COG)-affiliated institution.
- At least 8 years old and younger than 16 years old
- Diagnosed with childhood cancer, in remission
- Completed therapy within the past 12 months
- Performance status corresponding to ECOG scores of 0, 1, 2
- Fewer than 420 minutes of moderate to vigorous physical activity (MVPA) over the last week
- Able to write and read English, Spanish or French (patient and at least one parent/guardian)
- Not pregnant
AML23: Clinical Trial Studying the Safety of Using Venetoclax and Chemotherapy to Treat Newly Diagnosed Childhood AML
A Collaborative Phase 2 Study of Venetoclax in Combination with Conventional Chemotherapy in Pediatric Patients with Acute Myeloid Leukemia
Diseases Treated:
Eligibility:
- Diagnosed with AML
- Older than 28 days and younger than 22 years
- No prior AML treatment
APAL2020D: Venetoclax in Children with Relapsed Acute Myeloid Leukemia (AML)
A Randomized Phase 3 Trial of Fludarabine/Cytarabine/Gemtuzumab Ozogamicin With or Without Venetoclax in Children With Relapsed AML
Diseases Treated:
Eligibility:
- Diagnosis of relapsed acute myeloid leukemia (AML)
- Ages 29 days old to 21 years old
- Have had AML come back for the first or second time
- May have heart problems that prevent them from taking anthracyclines
APNEA: Sleep Apnea in Hodgkin Lymphoma Survivors Treated with Radiation to the Chest
Obstructive Sleep Apnea in Survivors of Hodgkin Lymphoma Treated with Thoracic Radiation
Diseases Treated:
Eligibility:
Hodgkin lymphoma survivor
- Patient eligible for the St. Jude LIFE study
- Treated with thoracic radiation for Hodgkin lymphoma
- At least 18 years old
- At least 5 years from original diagnosis
- If participating remotely, must have Wi-Fi access
Comparison group
- Non-patient volunteer (Cannot be sibling, parent or child of the survivor participant)
- At least 18 years old
- Lives in the U.S.
- If participating remotely, must have Wi-Fi access
CATCHAML: CAR T-Cell Therapy for Acute Myelogenous Leukemia (AML)
CATCHAML: CD123-Directed Autologous T-Cell Therapy for Acute Myelogenous Leukemia
Diseases Treated:
Eligibility:
- 21 years old or younger
- Relapsed/refractory CD123+ AML, B-ALL, T-ALL or blastic plasmacytoid dendritic cell neoplasm
- Has a suitable bone marrow transplant donor for allogeneic bone marrow transplant
cHOD17: Risk-Adapted Therapy for Children and Young Adults with Hodgkin Lymphoma
Pediatric Classical Hodgkin Lymphoma Consortium Study
Diseases Treated:
Eligibility:
- Previously untreated CD30+ classical Hodgkin lymphoma
- 21 years or younger at time of diagnosis (low-risk and intermediate-risk patients)
- 25 years or younger (high-risk patients)
CN160: Ruxolitinib Therapy in Children after Bone Marrow Transplant
A Phase II Pediatric Study of a Graft-vs.-host disease (GVHD) prophylaxis regimen with no calcineurin inhibitors after day +60 post first allogeneic hematopoietic cell transplant for hematological malignancies
Diseases Treated:
- Acute lymphoblastic leukemia
- Acute myeloid leukemia
- Myelodysplasia
- Hodgkin lymphoma
- Non-Hodgkin lymphoma
- Juvenile myelomonocytic leukemia
Eligibility:
- Ages 12–21 years
- Lymphoid or myeloid-based cancer that requires a bone marrow transplant
CPXSMN: CPX-351 in Pediatric Patients with Secondary Myeloid Neoplasms
A Prospective, Multicenter, Single-Arm Pilot Study of CPX-351 (VYXEOS) in Individuals < 22 Years with Secondary Myeloid Neoplasms
Diseases Treated:
Eligibility:
- 1–22 years old
- Treatment-related or secondary MDS/AML
DIRECT70: CAR T–Cell Therapy for Children with Blood Malignancies
CAR T–Cell Therapy Directed to CD70 for Pediatric Patients with Hematological Malignancies (DIRECT70)
Diseases Treated:
Eligibility:
- Up to 21 years old
- CD70+ acute myeloid leukemia, acute lymphoblastic leukemia (B-ALL, T-ALL), lymphoma, or myelodysplastic syndrome
- If prior allogeneic hematopoietic cell transplant, no graft vs. host disease
- Has an identified hematopoietic cell transplantation donor
- Has adequate organ function
DSCOG: Learning, Behavior and Social Skills in Survivors of Childhood Leukemia with Down syndrome
Neurocognitive and Psychosocial Outcomes in Survivors of Childhood Leukemia with Down syndrome
Diseases Treated:
Eligibility:
This is a non-therapeutic clinical trial that is open only to patients who were treated at St. Jude Children’s Research Hospital since 1980 and are currently followed at the hospital.
- St. Jude Children’s Research Hospital patient with acute leukemia (i.e., ALL or AML)
- Trisomy 21 Down syndrome diagnosis
- Completed all cancer therapy at St. Jude since 1980 and at least six months prior to study visit
- English as the primary language
G4K: Genomes for Kids
Next Generation Sequencing of Normal Tissue Prospectively in Pediatric Oncology Patients
Diseases Treated:
Non-therapeutic
Eligibility:
This is a non-therapeutic clinical trial that is open to St. Jude patients.
- Solid tumor or liquid tumor (cancerous or non-cancerous)
HAP2HCT: Partially Matched Family Donor Bone Marrow Transplant in Children and Young Adults with High Risk Cancer
TCRαβ-depleted Progenitor Cell Graft with Additional Memory T-Cell DLI, plus Selected Use of Blinatumomab, in Naïve T-Cell depleted Haploidentical Donor Hematopoietic Cell Transplantation for Hematologic Malignancies
Diseases Treated:
- Acute lymphoblastic leukemia
- Acute myeloid leukemia
- Myelodysplasia
- Hodgkin lymphoma
- Non-Hodgkin lymphoma
- Juvenile myelomonocytic leukemia
Eligibility:
For transplant recipient:
- 21 years or younger
- Does not have a suitable sibling donor or volunteer unrelated donor
- Has a suitable single haplotype matched family member donor
- Diagnosed with high risk hematologic malignancy
- No prior allogeneic hematopoietic cell transplant
HAPNK1: Blood and Marrow Transplant (BMT) for Children with Leukemia/Lymphoma
Haploidentical Donor Hematopoietic Progenitor Cell and Natural Killer Cell Transplantation with a TLI-Based Conditioning Regimen in Patients with Hematologic Malignancies
Diseases Treated:
Eligibility:
- 21 years and younger
- Does not have a suitable HLA-matched sibling donor or volunteer HLA-matched unrelated donor or is not a candidate for conventional matched donor transplant due to refractory disease
- Has a suitable single haplotype-matched family member donor
- High-risk hematologic malignancy, including certain diagnoses of:
- Acute lymphoblastic leukemia (ALL)
- Acute myeloid leukemia (AML)
- Chronic myelogenous leukemia (CML)
- Myelodysplastic syndrome (MDS)
- Hodgkin lymphoma
- Non-Hodgkin lymphoma
INOMRD: Inotuzumab Ozogamicin for Children with High-Risk B-Cell ALL
Inotuzumab Ozogamicin for Children with MRD Positive CD22+ Acute Lymphoblastic Leukemia
Diseases Treated:
Eligibility:
- Younger than 22 years old
- Diagnosis of B-cell acute lymphoblastic leukemia (B-ALL) with minimal residual disease (MRD) between 0.1 and 4.99% after prior chemotherapy, relapse or stem cell transplant
MEMCAR19: Allogeneic CAR T-Cell Therapy for Relapsed/Refractory CD19-Positive Leukemia
Phase I Study Evaluating Allogeneic Memory T Cells Engineered to Express Chimeric Antigen Receptors Specific for CD19 for the Treatment of Pediatric and Young Adult Patients with Relapsed or Refractory CD19-positive Leukemia
Diseases Treated:
Eligibility:
Donor eligibility includes:
- At least 18 years old
- At least single haplotype matched family member
- HIV negative
- Not pregnant or breastfeeding
- Completed the process of donor eligibility determination as defined in the study
Recipient eligibility includes:
- 21 years old or younger*
- Diagnosed with relapsed and/or refractory CD19-positive leukemia (as defined in the study)
- Cohort A only – Relapsed and/or refractory CD19-positive leukemia AND previously received a hematopoietic cell transplant from the selected CAR-T donor
- Cohort B only: Can not receive autologous CD19-CAR T-cell therapy (as defined in the study)
- Detectable CD19+ leukemia in the bone marrow
- Adequate organ function (as defined in the study)
* Initial 3 participants must be at least 12 years old.
NCBP01: Safety Study of Unlicensed, Investigational Cord Blood Units Manufactured by the NCBP for Unrelated Transplantation
A Multicenter Safety Study of Unlicensed, Investigational Cryopreserved Cord Blood Units (CBUs) manufactured by the National Cord Blood Program (NCBP) and provided for Unrelated Hematopoietic Stem Cell Transplantation of Pediatric and Adult Patients
Diseases Treated:
Leukemia and other blood diseases
Eligibility:
This is a non-therapeutic clinical trial that is only open to St. Jude patients.
- Participant is receiving an allogeneic hematopoietic stem cell (HSC) transplant at St. Jude Children's Research Hospital using an unlicensed cord blood unit (CBU).
- Participant may be of any age and either gender.
- Participant has a medical disorder affecting the hematopoietic system that is inherited, acquired, or a result from myeloablative treatment.
- Participant is receiving HPC-CORD BLOOD product manufactured by NCBP (at least one, if the graft contains more than one units).
PAINBDY1: Treating Pain in Children with Cancer: Pain Buddy
Treating Pain in Children with Cancer: A 21st Century Innovative Approach (Pain Buddy)
Diseases Treated:
ALL
AML
Carcinoma
Endocrine Tumors
Lymphoma
Melanoma
Neuroblastoma
Retinoblastoma
Ewing Sarcoma
Osteosarcoma
Rhabdomyosarcoma
Sarcomas
Eligibility:
This is a research study open only to St. Jude patients and their caregivers.
- 8 to 18 years old
- Within 16 weeks of initial cancer diagnosis
- Receiving outpatient chemotherapy treatment for cancer
- Can speak, read and write English. Parents who can speak, read, and write in English and Spanish
- Have Internet access
PEPN1812 : Study of Flotetuzumab in Children with Relapsed or Refractory Acute Myeloid Leukemia
Phase I Trial of Flotetuzumab, a CD123 X CD3 Dual Affinity Re-Targeting (DART) Molecule, in Pediatric Patients with Relapsed/Refractory AML
Diseases Treated:
Eligibility:
- Younger than 21 years of age
- Diagnosed with recurrent or refractory acute myeloid leukemia (AML)
- Weigh more than 17kg
- Fully recovered from the acute toxic effects of all prior anti-cancer therapy
PEPN2111: Study of CBL0137 in Patients with Relapsed or Refractory Solid Tumors and Lymphoma
A Phase 1/2 Trial of CBL0137 in Patients with Relapsed or Refractory Solid Tumors including CNS Tumors and Lymphoma
Diseases Treated:
Eligibility:
- 12 months to 21 years old with diagnosis of:
- Relapsed or refractory solid tumor or lymphoma (including CNS tumors) OR
- Progressive or recurrent DIPG or other H3 K27M-mutant diffuse midline gliomas previously treated with radiation therapy
- 12 months to 30 years old with diagnosis of relapsed or refractory osteosarcoma
RAVEN: Clinical Trial to Treat Relapsed Acute Lymphoblastic Leukemia with Venetoclax and Navitoclax
A Phase I/II Trial Treating Relapsed Acute Lymphoblastic Leukemia with Venetoclax and Navitoclax
Diseases Treated:
Acute Lymphoblastic Leukemia and Lymphoma
Eligibility:
- Diagnosed with relapsed or refractory acute lymphoblastic leukemia or lymphoma
- Between 4 and 22 years old
- Weigh more than 20 kg (44.09 lbs.)
- Able to swallow pills
- No prior exposure to navitoclax
- Fully recovered from effects of any prior treatment
REF2HCT: Haploidentical Bone Marrow Transplant for Leukemia and Lymphoma
Provision of TCRγδ T Cells and Memory T Cells plus Selected Use of Blinatumomab in Naïve T-cell Depleted Haploidentical Donor Hematopoietic Cell Transplantation for Hematologic Malignancies Relapsed or Refractory despite Prior Transplantation
Diseases Treated:
- Leukemia
- Lymphoma
- Myeloid sarcoma
- Myelodysplastic syndrome
Eligibility:
- 21 years old and younger
- Diagnosed with one of the following that has come back or did not improve after bone marrow transplant
- Acute lymphoblastic leukemia (ALL)
- Acute myeloid leukemia
- Myeloid sarcoma
- Chronic myeloid leukemia (CML)
- Juvenile myelomonocytic leukemia (JMML)
- Myelodysplastic syndrome (MDS)
- Non-Hodgkin lymphoma (NHL)
- Has a family member who is a suitable stem cell donor
SJCAR19: CAR T-Cell Therapy for Children and Young Adults with Acute Lymphoblastic Leukemia
A Phase I/II Study Evaluating CD19-Specific CAR Engineered Autologous T-Cells in Pediatric and Young Adult Patients with Relapsed or Refractory CD19+ Acute Lymphoblastic Leukemia
Diseases Treated:
Eligibility:
- Children and young adults up to 21 years old
- Refractory or relapsed CD19+ acute lymphoblastic leukemia (ALL)
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