Pediatric Lymphoma

• What is lymphoma?
  • Lymphoma is a cancer that affects the white blood cells. They arise from the lymphatic system, a part of the immune system, and can start in any area of the body where lymphatic tissue aggregates, such as lymph nodes, bone marrow, liver or spleen. These white cells normally fight infection and help protect the body against disease. Patients with lymphoma have too many abnormal white blood cells in their lymphatic system. Classically, lymphomas have been divided into two groups: Hodgkin’s and non-Hodgkin’s. However, these two groups are very different, and treatment and prognosis for the various types of lymphoma can vary drastically.
• What are the symptoms of lymphoma?
  • Symptoms of ALL include:
    • Painless swelling of a lymph node
    • Fever or night sweats
    • Weight loss or fatigue
    • Pain in the bones or joints
    • Lumps in the neck, underarm, stomach or groin
    • Weakness, paleness or loss of appetite
    • Shortness of breath
• How common is acute lymphoblastic leukemia?
  • Lymphomas as a group are the 3^rd most common type of childhood cancer, after leukemia and brain tumors. Hodgkin’s lymphoma affects about 1 in 28,500 people, and about 3,000 children younger than age 20 are found to have ALL each year in the United States. Siblings of children with leukemia have a slightly higher risk of developing ALL, but the rate is still quite low: no more than 1 in 500. It occurs most commonly in children 2 to 4 years of age.
• What are the survival rates for acute lymphoblastic leukemia?
  • About 98 percent of children with ALL go into remission within 4 weeks of starting treatment.
  • Around 90 percent of children with ALL can be cured. Patients are considered cured after 5 years in remission.
  • Certain types of ALL may have slightly higher or lower cure rates.

The diagnosis of acute lymphoblastic leukemia in children is based on a complete medical history and physical examination and on the following diagnostic tests:

• Complete blood count (CBC). Blood drawn is used to look at the white blood cell number, as well as platelets. Blood tests may be done to evaluate the liver and kidneys and how the blood is clotting.
• Bone marrow aspirate and biopsy. Bone marrow aspirates and biopsies involve inserting a needle into a bone in the pelvis and removing about 2 teaspoons of marrow for examination. Bone marrow studies usually require sedation or general anesthesia.
• Lumbar puncture (spinal tap). Spinal taps involve inserting a needle into the lower back, between the bones of the spinal column or backbone, to remove the fluid that surrounds the brain and spinal cord. The same needle can be used to insert medicines to prevent or treat leukemia in the brain or spinal cord (intrathecal chemotherapy). Lumbar punctures are often done under sedation.
• Chest X-ray. Chest X-rays are taken to see if there is a mass of cells in the thymus that may affect breathing.

How is acute lymphoblastic leukemia treated?

• ALL treatment includes three phases:
  • Induction — The purpose of this phase, which often occurs in the hospital, is to kill the leukemia cells in the blood and bone marrow and put the disease into remission (a return to normal blood cell counts)
  • Consolidation/intensification — The purpose of this phase is to rid the body of any remaining cells that could begin to grow and cause the leukemia to relapse
  • Maintenance — to destroy any cancer cells that might have survived the first two phases
• Four types of treatment may be used during any of these treatment phases:
  • Chemotherapy (“chemo”)—uses powerful medicines to kill cancer cells or stop them from growing (dividing) and making more cancer cells.
  • Stem cell transplant — This involves destroying the blood forming cells in the bone marrow with high-dose chemotherapy and radiation, then replacing them with cells from a donor
    • A stem cell transplant gives the patient new blood cells and a new immune system from a donor’s blood or bone marrow.
    • Some types of stem cell transplants may be called “bone marrow transplants” because the cells come from the donor’s bone marrow.
  • Radiation therapy — While infrequently used, high-energy X-rays or other types of radiation can kill cancer cells or stop them from growing.
  • Targeted therapy — Newer medicines are now available that target and attack specific cancer cells without harming normal cells. Many of these medicines are still considered experimental.

What clinical trials does Ochsner Children’s Hospital offer for leukemia treatment?

• As part of the Children’s Oncology Group, Ochsner Children’s Hospital is an active participant in children’s cancer research. We currently have multiple clinical trials available to treat children and young adults with leukemia.
• View Active clinical trials for ALL at Ochsner Children's.