Non-Hodgkin Lymphoma

What is non-Hodgkin lymphoma?

Lymphoma is cancer that starts in white blood cells (lymphocytes) that are part of the body’s immune system.

There are 2 main types:

They differ in how they:

  • Spread
  • Affect the body
  • Respond to treatment

Lymphoma can start anywhere in the lymph system and can spread to other parts of the body. Doctors do not know the exact cause of non-Hodgkin lymphoma. There is no known way to prevent it.

Non-Hodgkin Lymphoma at Seattle Children’s

To have the best chance of a cure, your child needs a team experienced in treating non-Hodgkin lymphoma in children and young adults. Each year our Leukemia and Lymphoma Program team cares for many families dealing with NHL. Some are just starting treatment. Others have refractory or relapsed disease. Our entire focus is on helping your child beat their disease and thrive. 

If you would like an appointment, ask your primary care provider to refer you to Seattle Children’s Cancer and Blood Disorders Center.

If you have a referral or would like a second opinion, contact the center at 206-987-2106 or by email.

Providers, see how to refer a patient.

  • Among the nation’s best cancer programs
    • We treat more young people with lymphoma than any other center in the region. See our statistics and outcomes.
    • 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 named our partnership a comprehensive cancer center.
    • A doctor specially trained in diagnosing and treating cancer in children (pediatric oncologist) will guide your child’s care. Our team’s experience helps us recommend the right treatment at the right time to have the best results for your child and your family.
  • Advanced therapies and clinical trials
    • Our approach to treatment will depend on your child’s specific type of non-Hodgkin lymphoma and how it responds to treatment. This is called risk-adapted, response-driven therapy. Our goal is to cure your child’s disease and limit any long-term effects from treatment.
    • We offer advanced treatment options such as targeted therapy, chemotherapy, stem cell transplants, surgery, radiation therapy and new approaches offered in research studies.
    • For children who need stem cell transplants, we work closely with Fred Hutch, whose doctors pioneered this lifesaving treatment. Our team works with your family through the whole process – preparing for transplant, doing the transplant here at Seattle Children’s and caring for your child as they recover.
    • Our doctors are leaders in lymphoma research, such as using a child’s immune system to fight cancer (immunotherapy). 
    • As research leaders, we can offer our patients the very latest treatments being studied, including phase 1 clinical trials. We have one of the nation’s largest pipelines of CAR T-cell immunotherapy trials for children and young adults.
    • Read more about cancer research and clinical trials at Seattle Children’s.
  • Complete care from birth to young adulthood
    • Our specialty is treating children’s cancer while helping them grow up to be healthy and productive adults. We take care of your child from diagnosis through all phases of treatment and follow-up survivor care.
    • Our team cares for your whole child. We don’t just treat their disease. As needed, your child will receive care from specialists in nutrition, pain management, pharmacy, palliative care, physical therapy and emotional health. Read more about the supportive care we offer.
    • Children do not react to illness, injury, pain and medicine in the same way as adults. They need – and deserve – care designed just for them. Our experts focus on how treatments today affect growing bodies in the future. We plan your child’s treatment based on our years of experience and the newest research on what is best and safest for children.
    • We know that teens and young adults with cancer have different challenges than young children. Our Adolescent and Young Adult Cancer Program focuses on their needs, which may include fertility preservation.
    • People who have been cured of cancer may be affected for months or years by their disease or treatment. Our Cancer Survivor Program provides long-term follow-up care to help children and young adults stay healthy after being treated for cancer in childhood.
  • Support for your whole family
    • Learning that your child has 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. If needs are not urgent, new patients can be seen in 1 to 2 weeks.
    • During visits, we take time to explain your child’s condition. We help you fully understand 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.
    • We work with 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

Symptoms can happen quickly or may appear slowly over several months. 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
  • Swelling in the head, neck, upper arms or chest
  • Trouble swallowing
  • Swollen lymph nodes in the neck, underarm, chest, belly, pelvis or groin
  • Unexplained fever, weight loss or night sweats

Diagnosing Non-Hodgkin Lymphoma

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

  • Check your child to look for signs of the disease.
  • Ask about your child's health.
  • Test your child’s blood. We check how many cells of each type are moving through your child’s bloodstream. Another test looks for chemicals in the blood that may be signs of cancer.
  • Have a surgeon take a sample of tissue (biopsy) or use a needle to sample tissue or fluid around the lungs or 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)
  • PET (positron emission tomography) scan

Your child's doctor may do further tests to tell if the cancer has spread to other parts of the body, such as testing fluid from the spinal column. This is called a lumbar puncture or spinal tap.

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.

Types of non-Hodgkin lymphoma

These types of NHL are more likely to affect children and teens:

  • Burkitt lymphoma (BER-kit lim-FOH-muh)
  • Lymphoblastic lymphoma (LIM-foh-BLAS-tik lim-FOH-muh)
  • Anaplastic large cell lymphoma (A-nuh-PLAS-tik larj sel lim-FOH-muh)
  • Diffuse large B-cell lymphoma (dih-FYOOS larj B-sel lim-FOH-muh)

Doctors divide NHL 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

Stages of non-Hodgkin lymphoma

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.

Treating Non-Hodgkin Lymphoma

Our goal is to give your child or teen the best chance of a long and healthy life. We offer the most advanced treatments for non-Hodgkin lymphoma in our region.

Your child's doctor and health care team will suggest a treatment plan for your child based on:

  • The type of NHL
  • The stage of the disease
  • If it has spread and how widely
  • Your child's overall health
  • Your family’s preferences

Treatment Options for Non-Hodgkin Lymphoma

We are experienced with all treatment options for non-Hodgkin lymphoma, including using a child’s immune system to fight cancer (immunotherapy). We also offer research studies of the newest treatments. We strive to improve cure rates while reducing the harsh effects from traditional treatments like chemotherapy or radiation therapy.

  • Targeted therapy

    Targeted therapy fights cancer by finding a specific 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.

  • Clinical trials, including immunotherapy

    Many children with NHL take part in research studies along with their standard medical treatment. Your child’s doctor will talk with you about any new options that might help your child. Then you can decide if you want to take part. It is always your choice.

    As leaders in pediatric cancer research, we can offer our patients options that are not available at all centers, such as phase 1 and 2 clinical trials of the newest treatments. Options offered at Seattle Children’s include:

    • Reprogramming the body’s infection-fighting T cells to find and destroy cancer cells. Learn about our PLAT immunotherapy for lymphoma that is hard to treat or relapses.
    • Targeted therapies that attach to specific proteins on lymphoma cells and help kill the cancer cells.
    • Different mixes and doses of chemotherapy medicines.
    • Options for children who do not have a good stem cell donor match.

    Learn more about cancer clinical trials at Seattle Children’s

  • Chemotherapy

    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.

    Our patients receive chemotherapy at our hospital campus in Seattle. Depending on your child’s type of NHL, they will get chemotherapy at our outpatient infusion center as a day procedure or overnight in our Cancer and Blood Disorders Center - Inpatient.

    See more about getting chemotherapy at Seattle Children’s.

  • Surgery

    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).

    • 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 whole tumor during a biopsy surgery.
    • 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 cancer cells that remain.

    We do surgery at our hospital campus in Seattle. Learn more about surgery to treat tumors at Seattle Children’s.

  • Radiation therapy

    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 affects their breathing or blood flow from the heart.
    • Combined with chemotherapy to treat NHL 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.

    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.

  • High-dose chemotherapy and stem cell transplant

    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 stem cell transplant.

    Depending on the type of NHL and how quickly it came back or stopped responding, the team may recommend using your child’s own hematopoietic stem cells or those from a donor. We do the transplants here at Seattle Children's, working closely with our partner 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.

Follow-Up Care

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

For most children, 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  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. 

Contact Us 

If you would like an appointment, ask your child’s primary care provider to refer you.

If you have a referral or would like a second opinion, contact the Cancer and Blood Disorders Center at 206-987-2106 or by email.

Providers, see how to refer a patient.

Related Links

Paying for Care

Learn about paying for care at Seattle Children’s, including insurance coverage, billing and financial assistance.

For Healthcare Professionals