Non-Hodgkin's Lymphoma in Children

Non-Hodgkin's lymphoma in children is the collective name of a group of systemic malignant tumors of the immune system originating from cells of the extraosthenal lymphoid tissue.

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Epidemiology of non-Hodgkin's lymphomas

Incidence of childhood non-Hodgkin's lymphomas in Europe. North America and Russia are 6-10 cases per 1,000,000 children. Non-Hodgkin's lymphomas account for 5-7% of all malignant tumors of childhood. The peak incidence is 5-10 years, children under 3 years are extremely ill. Among the patients under the age of 14, boys predominate significantly: the ratio of boys to girls is 3.2: 1 according to domestic authors. In adolescents, this indicator varies due to an increase in the frequency of non-Hodgkin's lymphomas in girls and is 1.4: 1.

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Symptoms of non-Hodgkin's lymphomas in children

The anamnesis is not long, the symptoms of biological activity are noted in no more than 10-15% of patients. Clinical manifestations are mainly due to localization and mass of the tumor. In children, 40-50% of non-Hodgkin's lymphomas are initially localized in the abdominal cavity: in the ileocecal region, appendix, ascending colon, mesenteric and other groups of intra-abdominal lymph nodes. An increase in the abdomen with a general satisfactory state of the child may be the first symptom of the disease. With a physical examination, you can propalpate the tumor or identify ascites, hepatosplenomegaly.

Symptoms of non-Hodgkin's lymphomas

Classification of non-Hodgkin's lymphomas

Non-Hodgkin's lymphomas are tumors from lymphoid cells of different histogenetic affiliation and degree of differentiation. The group includes more than 25 diseases. Differences in the biology of non-Hodgkin's lymphomas are due to the characteristics of the cells that form them. It is the constituent cells that determine the clinical picture, the sensitivity to therapy and the long-term prognosis. For most lymphomas, specific nonrandom chromosomal translocations and rearrangements of receptors are known, which are key in pathogenesis.

Classification of non-Hodgkin's lymphomas

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Diagnosis of non-Hodgkin's lymphomas in children

The complex of necessary diagnostic tests for suspected non-Hodgkin's lymphoma includes the following measures.

• Anamnesis and detailed examination with assessment of the size and consistency of all groups of lymph nodes.
• Clinical blood count with platelet count (deviations are more often absent, cytopenia is possible).
• Biochemical blood test with assessment of liver function, kidney function, determination of LDH activity, the increase of which has diagnostic value and characterizes tumor size.
• The bone marrow examination for the detection of tumor cells is a puncture from three points with myelogram counting; determine the percentage of normal and malignant cells, their immunophenotype.
• Lumbar puncture with morphological examination of the cytokine preparation for detection of CNS lesion (presence of tumor cells in the cerebrospinal fluid is possible).

Diagnosis of non-Hodgkin's lymphomas

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Treatment of non-Hodgkin's lymphomas in children

It is important to adequately treat the initial syndromes caused by the localization and mass of the tumor (contraction syndromes) and metabolic disorders due to its disintegration (tumor lysis syndrome). In the case of non-Hodgkin's lymphoma, therapeutic measures begin immediately when a patient enters the hospital from providing venous access, resolving the question of the need for and the nature of infusion and antibacterial therapy. Initial therapy is carried out through a peripheral catheter, central vein catheterization is performed under general anesthesia concurrently with diagnostic procedures. Obligatory monitoring of biochemical indicators for the timely detection of metabolic disorders.

How are non-Hodgkin's lymphomas treated?