Cancers and Tumors

Non-Hodgkin Lymphoma

What is non-Hodgkin lymphoma?

Lymphoma is cancer of the lymph system. It can start anywhere in the lymph system and can spread to other parts of the body.

There are 2 main types of lymphoma:

  • Non-Hodgkin lymphoma
  • Hodgkin lymphoma, also called Hodgkin disease or Hodgkin’s disease

Hodgkin lymphoma and non-Hodgkin lymphoma are different in how they:

  • Spread
  • Affect the body
  • Respond to treatment

To have the best chance of a cure, your child needs care by a team experienced in treating this cancer in children. Doctors in our Leukemia and Lymphoma Program are recognized as national leaders in caring for children with non-Hodgkin lymphoma.

  • The lymph system is a network of small vessels that collect a watery fluid (lymph) from all around the body. It is part of your child’s immune system.

    White blood cells called lymphocytes travel in the lymph, fighting infection and disease. Along the network of lymph vessels are bean-like structures called lymph nodes. They filter the lymph and serve as centers where the body fights disease.

  • Doctors do not know the exact cause of non-Hodgkin lymphoma. There is no known way to prevent it.

    Most children who have non-Hodgkin lymphoma have no clear risk factors. But the chance of this cancer is higher in children who:

    • Have a genetic disorder that interferes with their immune system
    • Had their immune system suppressed with medicines after an organ transplant
    • Have a weak immune system because of human immunodeficiency virus (HIV)
    • Were infected with the Epstein-Barr virus (pronounced ep-stine-BAR VY-rus)
    • Were exposed to radiation such as from a nuclear reactor

Non-Hodgkin Lymphoma at Seattle Children’s

At Seattle Children’s, we care for many families each year who have a child with non-Hodgkin lymphoma. Many of the children we treat return to their normal lives after treatment and never have cancer again.

The experts in our Leukemia and Lymphoma Program provide advanced therapies for children with all types of non-Hodgkin lymphoma, including lymphoma that recurs. We treat more young people with lymphoma and leukemia than any other center in the region. See our statistics and outcomes.

The program is part of the Cancer and Blood Disorders Center at Seattle Children’s. Please contact the center at 206-987-2106 for more information, a second opinion or to make an appointment.

  • A doctor specially trained in diagnosing and treating cancer in children (pediatric oncologist) will guide your child’s care. Your child’s team will also include a nurse practitioner and a social worker.

    We care for your whole child. We don’t just treat their lymphoma. Your family has a full team behind you, including specialists in nutrition, pain management, pharmacy, physical therapy, psychology and emotional health. Read more about the supportive care we offer.

    Treatment options for non-Hodgkin’s lymphoma include new mixes of medicine (chemotherapy and targeted therapy), stem cell transplants, surgery, radiation therapy and new approaches offered in research studies.

    We provide stem cell transplants through our partner in the Seattle Cancer Care Alliance, Fred Hutch. Thirty years ago, Fred Hutch pioneered this lifesaving procedure. If your child needs a stem cell transplant, their cancer doctor will work closely with the transplant team to plan their treatment. The plan includes:

    • How to get your child’s disease in remission
    • The best kind of transplant for your child
    • How to reduce the risk of cancer coming back after transplant

  • For the past decade, U.S. News & World Report has consistently ranked Seattle Children's Cancer Center among the best in the nation. In 2017, our program was ranked #1 in the Northwest.

    Our outcomes for non-Hodgkin lymphoma are better than the national average.

    Through our partnership in the Seattle Cancer Care Alliance (SCCA), your child will benefit from the work of physician-scientists at Fred Hutch and UW Medicine, as well as at Seattle Children’s. The National Cancer Institute has designated our partnership a comprehensive cancer center.

    Our experience helps us recommend the right treatment at the right time to have the best results for your child and your family.

  • At Seattle Children’s, your child’s treatment for non-Hodgkin lymphoma depends on their disease and how it responds to the first type of therapy given. This is known as risk-adapted, response-driven therapy. It is designed both to cure the disease and to limit any long-term effects from the treatment.

    Our doctors are leaders in lymphoma research. Dr. Rebecca Gardner serves on the non-Hodgkin lymphoma committee of the Children’s Oncology Group (COG). COG is an international organization of childhood cancer specialists who study many forms of childhood cancer. COG aims to understand better how cancer works, develop new treatments and reduce later effects of the disease and treatments. The knowledge we gain through research improves the care we give all children with cancer.

    Our patients have access to the very latest treatments being studied, including Phase 1 clinical trials. We work hard to find the best possible research study for your child, depending on their specific type of non-Hodgkin lymphoma. Options for your child at Seattle Children’s may include using their own disease-fighting T cells and monoclonal antibodies that target specific proteins (receptors) on lymphoma cells and help kill the cancer cells.

    Read more about cancer research and clinical trials at Seattle Children’s. You can search by diagnosis for many clinical trials available through Seattle Children’s on ClinicalTrials.gov. Read our guide about searching for trials on ClinicalTrials.gov (PDF). You can search for bone marrow transplant clinical trials on Fred Hutch’s clinical trials page.

  • Our specialty is treating children’s cancer while helping them grow up to be healthy and productive adults.

    Children don’t react to illness, injury, pain and medicine in the same way as adults. They need – and deserve – care designed just for them.

    Our cancer doctors have special training in how to diagnose and treat children with cancer. They focus on how treatments today affect growing bodies in the future. Their treatment plans are based on years of experience and the newest research on what works best – and most safely – for children.

  • A diagnosis of non-Hodgkin lymphoma can be scary. We help take positive steps right away by offering appointments in 1 to 3 days to children suspected to have cancer.

    During visits, we take time to explain your child’s condition. We help you fully understand your treatment options and make the choices that are right for your family.

    Our child life specialists and social workers help your child and your family through the challenges of cancer. We connect you to community resources and support groups.

    At Seattle Children’s, we work with many children and families from around the Northwest and beyond. Whether you live nearby or far away, we can help with financial counseling, schooling, housing, transportation, interpreter services and spiritual care. Read about our services for patients and families.

Symptoms of Non-Hodgkin Lymphoma

These symptoms may be caused by non-Hodgkin lymphoma or by another condition. Check with a doctor if your child has any of these:

  • Shortness of breath, breathing trouble, wheezing or high-pitched breathing. These may happen if your child’s thymus or lymph nodes in the chest are larger than normal.
  • Swelling in the head, neck, upper arms or chest. This may be caused by lymphoma pressing on the main vein that drains blood from these areas.
  • Trouble swallowing.
  • Swollen lymph nodes in the neck, underarm, chest, belly, pelvis or groin.
  • Unexplained fever, weight loss or night sweats.
  • Symptoms can happen quickly or may appear slowly over several months.

H2. Diagnosing Non-Hodgkin Lymphoma

To find out whether your child has non-Hodgkin lymphoma, your child’s doctor will:

  • Do an exam to look for signs of the disease.
  • Ask about your child’s health.
  • Take a sample of tissue by surgery (biopsy) or use a needle to sample tissue or fluid around the lungs or organs in the belly.

Your doctor will want to take pictures of the inside of your child’s body (imaging studies). These help show enlarged lymph nodes, tumors or areas where cancer is active. Imaging studies may include:

  • X-ray of the chest
  • CT (computed tomography) scan
  • Gallium scan
  • Positron emission tomography (PET) scan

Your child’s doctor may do further tests to tell if the cancer has spread around the lymph system or to other parts of the body.

The tests may include:

  • Complete blood count (CBC) – Tells how many cells of each type are moving through the bloodstream.
  • Blood chemistry – Finds chemicals in the blood that may be signs of cancer.
  • Lumbar puncture – Removes fluid from the spinal column and checks for cancer cells. Also called a spinal tap.
  • Bone marrow test – Helps tell if the disease has spread to the bone marrow (where the body makes blood cells).

Types and Stages of Non-Hodgkin Lymphoma

Knowing the type and stage of your child’s non-Hodgkin lymphoma helps doctors decide which treatments are most likely to work.

  • These types of non-Hodgkin lymphoma are more likely to affect children and teens:

    • Burkitt lymphoma
    • Lymphoblastic lymphoma
    • Anaplastic large cell lymphoma
    • Diffuse large B-cell lymphoma

    Doctors divide non-Hodgkin lymphoma into types and subtypes based on:

    • The specific type of cell affected
    • How mature the cells are
    • How the cells look under a microscope
    • The way the cells grow

  • It is important to find out how far cancer has spread and what body parts it affects. This process is called staging.

    Knowing the stage of your child’s cancer helps your doctor plan the right treatment. There are 4 stages of non-Hodgkin lymphoma. Most children have stage 3 or stage 4 disease by time they are diagnosed.

    Stage 1 non-Hodgkin lymphoma

    Applies to children who have both of these:

    • Non-Hodgkin lymphoma in only 1 area or lymph node
    • That area or node is not in the abdomen or chest

    Stage 2 non-Hodgkin lymphoma

    Applies to children who have any 1 of these:

    • Disease in only 1 area, including the lymph nodes in the area.
    • Disease in 2 or more areas or lymph nodes, with all the cancer either above the diaphragm or below the diaphragm. The diaphragm is the muscle that separates the chest and belly. It controls breathing.
    • Disease that started in the stomach or intestines and that was completely removed through surgery.

    Stage 3 non-Hodgkin lymphoma

    Applies to children who have any 1 of these:

    • Non-Hodgkin lymphoma is both above and below the diaphragm.
    • The disease started in the chest.
    • The disease is in 2 or more areas in the belly.
    • The disease is around the spine.

    Stage 4 non-Hodgkin lymphoma

    Applies to children who have non-Hodgkin lymphoma in their bone marrow, brain, spine or cerebrospinal fluid (CSF).

    If more than 25% of the bone marrow is cancer cells, the cancer is considered acute lymphoblastic leukemia (ALL) instead of lymphoma.

Treating Non-Hodgkin Lymphoma

Our Leukemia and Lymphoma Program offers the most advanced treatments for non-Hodgkin lymphoma in our region. Our patients have access to the newest options being studied in clinical trials of promising new therapies.

Our goal of treatment is to give your child or teen the best chance of a long and healthy life. Your child’s doctor and healthcare team will suggest a treatment plan for your child based on:

  • The type of lymphoma your child has
  • The stage of the disease
  • Whether it has spread and how widely
  • Your child’s overall health
  • Your family’s preferences

Treatment Options for Non-Hodgkin Lymphoma

  • Most children with non-Hodgkin lymphoma are treated with chemotherapy using more than 1 medicine. Chemotherapy means giving medicines to kill cancer cells. These medicines spread around the body through the bloodstream. They attack cancer cells that are in the blood, the lymph system and other parts of the body.

    • For non-Hodgkin lymphoma, most chemotherapy is given through a vein, which is called intravenous (IV). Some children also get chemotherapy by mouth.
    • If non-Hodgkin lymphoma has spread or may spread to your child’s brain and spinal cord, your child may get chemotherapy as a shot into the spinal column.
    • How long your child needs chemotherapy will depend on the type of cancer they have.

    Our patients receive chemotherapy at our hospital’s main campus in Seattle. Depending on your child’s type of non-Hodgkin lymphoma, they will get chemotherapy at our infusion center as a day procedure or overnight in our Cancer Care Unit.

    See more about getting chemotherapy at Seattle Children’s.

  • Often lymphoma spreads throughout the lymph system, so there is no specific tumor site. But in some children, large numbers of lymphoma cells collect in one area (called a tumor). Doctors may suggest surgery to remove the tumor.

    • The first surgery your child has may be a biopsy. Doctors remove a small sample of tumor cells to check for cancer.
    • If the tumor is only in a very limited area, doctors may try to remove the entire tumor during a biopsy surgery. But often, doctors need to do surgery after the biopsy to remove the tumor.
    • Even when doctors can remove the entire tumor, they may suspect or know that cancer cells are still in your child’s body. Doctors almost always use chemotherapy and sometimes radiation to kill remaining cancer cells.

    Surgery is done at our hospital’s main campus in Seattle.

    Learn more about surgery to treat tumors at Seattle Children’s.

  • Targeted therapy fights cancer by finding a specific substance (target), such as a protein on cancer cells or a substance that helps cancer grow. Different targeted therapies work in different ways. They may interfere with the cancer cells’ ability to grow, divide, make repairs or communicate with other cells.

    Doctors may suggest targeted therapy as part of your child’s standard treatment or in a clinical trial testing a new treatment.

  • Doctors rarely treat non-Hodgkin lymphoma with radiation therapy. But it may be:

    • Used as an emergency treatment to shrink a tumor in the chest. Your child may need this if the tumor is in the way of breathing or blood flow from the heart.
    • Combined with chemotherapy to treat non-Hodgkin lymphoma that has spread to the brain and spinal cord or to the testicles.

    Radiation therapy uses high-energy X-rays to kill cancer cells and reduce the size of any tumors. A machine outside the body delivers strong beams of X-rays. We focus beams as precisely as possible to help limit damage to healthy areas.

    Radiation can harm a young child’s developing nervous system or bones. Our radiation oncologist, Dr. Ralph Ermoian, is very experienced in treating children. He helps your child’s team decide if radiation may be helpful and what type of radiation to use.

    Learn more about Seattle Children’s Radiation Therapy Service.

  • If your child’s lymphoma does not go away completely with the first round of chemotherapy or comes back, your doctor may suggest high doses of chemotherapy followed by a transplant of their own blood-forming (hematopoietic) stem cells.

    High-dose chemotherapy treats tumors more effectively than lower-dose chemo. But the drugs damage the bone marrow’s ability to make new blood cells. That’s why your child needs a transplant of healthy, stored stem cells.

    A stem cell transplant using a child’s own cells is called autologous (aw-TAH-luh-gus). Before high-dose chemotherapy, doctors will remove stem cells from your child. The cells are frozen and stored. After chemotherapy is finished, doctors return the stem cells to your child’s body through a vein.

    In rare cases, doctors may transplant stem cells from a donor whose cells closely match your child’s. Your doctor may suggest this treatment if your child’s non-Hodgkin lymphoma comes back in the bone marrow or comes back after a transplant of their own stem cells. A transplant of another person’s stem cells is called allogeneic (A-loh-jeh-NAY-ik).

    Our patients who have a stem cell transplant receive this care through Seattle Children’s and our partner in the Seattle Cancer Care Alliance, Fred Hutch. Fred Hutch is one of the largest stem cell transplant centers in the world.

    Learn more about the Pediatric Blood and Marrow Transplant Program.

  • Many children, adolescents and young adults with lymphoma participate in research while receiving their standard medical treatment. Research studies of new drugs and other promising treatment approaches are called clinical or therapeutic trials.

    As a national research leader, Seattle Children’s can offer our patients the latest options through clinical trials, including Phase 1 studies. These early studies are especially important for children and teens with lymphoma that does not respond well to early treatment or that comes back.

    Newer options available at Seattle Children’s include:

    • Targeted therapies that attach to specific proteins on lymphoma cells or to substances that help cancer cells grow. One type of targeted therapy is monoclonal antibodies. These are manmade versions of antibodies –immune system proteins that fight disease.
    • Reprogramming the body’s infection-fighting T cells to find and destroy cancer cells. Our clinical trial of T-cell therapy for leukemia patients is also open to children and teens with some forms of non-Hodgkin lymphoma that has not responded to other treatment.
    • Different mixes and doses of chemotherapy medicines.
    • Options for children who do not have a good stem cell donor match. Dr. Colleen Delaney has developed ways to use umbilical cord blood to improve outcomes for children who need stem cell transplants.

    Learn more about cancer clinical trials at Seattle Children’s

Follow-up care

Follow-up care is important after treatment ends — no matter what type of therapy your child had. The follow-up routine will depend on your child’s cancer and their treatments.

Follow-up visits happen about every 3 months for the first year, then twice a year for the next year. After that, your child has 1 follow-up visit each year.

Most children visit the Leukemia and Lymphoma Clinic at Seattle Children’s for follow-up care. If you live far from Seattle, your child may see an oncologist in your own community.

During follow-up visits your child’s team will:

  • Look for any signs that cancer is returning
  • Check for effects that may happen months or years after treatment
  • Tell you and your child about any risk for other cancers and signs to watch for

Our Cancer Survivor Program provides long-term follow-up care to help young people stay healthy after being treated for cancer in childhood. Through our partnership in the Seattle Cancer Care Alliance, our patients who have had a stem cell transplant get care from the SCCA’s Long-Term Follow-Up program.

Contact Us

Contact the Cancer and Blood Disorders Center at 206-987-2106 for an appointment, a second opinion or more information.

To make an appointment, you can call us directly or get a referral from your child’s primary care provider. We encourage you to coordinate with your pediatrician or family doctor when coming to Seattle Children’s.

Providers, see how to refer a patient.