AIDS-Related Lymphoma in Children
What is AIDS-related lymphoma in a child?
AIDS-related lymphoma is a type of cancer called non-Hodgkin lymphoma. It grows in some people with AIDS. AIDS is a disease that weakens the immune system. AIDS raises the risk for long-term (chronic) disease, such as cancer.
AIDS-related lymphoma grows in the white blood cells of the lymphatic system. The lymphatic system is part of the immune system. It helps to fight diseases and infections. The lymphatic system also helps with balancing fluids in different parts of the body. The lymphatic system includes:
- Lymph. This is a fluid that contains lymphocyte cells.
- Lymph vessels. These are tiny tubes that carry lymph fluid throughout the body.
- Lymphocytes. These are a type of white blood cells that fight infections and disease. Burkitt lymphoma grows from B-cells, one type of lymphocyte.
- Lymph nodes. These are small bean-shaped organs. They are in the underarm, groin, neck, chest, abdomen, and other parts of the body. They filter the lymph fluid as it moves around the body.
- Other organs and body tissues. The lymphatic system includes the bone marrow where blood is made. And it includes the spleen, thymus, tonsils, and digestive tract.
AIDS-related lymphoma affects the body in 3 ways:
- Systemic. Lymphoma affects a large part of the body from the neck down. This includes the lymph nodes, spleen, and other organs.
- Primary central nervous system. Lymphoma affects the brain and spinal cord (central nervous system).
- Primary effusion. Lymphoma affects the lining of body cavities such as the chest (pleura), belly or abdomen (peritoneum), and sac containing the heart (pericardium).
The 3 main types of AIDS-related lymphoma are:
- Diffuse large B-cell lymphoma. This is the most common type of non-Hodgkin lymphoma. It grows very fast and can grow outside the lymphatic system.
- B-cell immunoblastic lymphoma. This type of lymphoma starts with B cells.
- Burkitt lymphoma. This is also known as small non-cleaved cell lymphoma. This is a very fast-growing lymphoma.
What causes AIDS-related lymphoma in a child?
HIV is the virus that causes AIDS. People are usually infected with HIV through contact with the blood or other body fluids of someone with HIV or AIDS. In children, this usually happens during pregnancy, labor and delivery, or breastfeeding with a mother who has HIV or AIDS.
The HIV virus attacks the body's immune system in people with AIDS. This makes it more difficult for the immune system to fight cancers and infections. People with AIDS have an increased chance of growing lymphoma and other types of cancer and very serious infections.
Which children are at risk for AIDS-related lymphoma?All people with AIDS are at risk of growing AIDS-related lymphoma. HIV/AIDS in children is most common in parts of Africa. HIV/AIDS in children, along with AIDS-related lymphoma in children, is far less common in other parts of the world.
What are the symptoms of AIDS-related lymphoma in a child?
Your child may have many different symptoms. It depends on the type of lymphoma and where it is located. Symptoms may include:
- Swollen, painless lymph nodes in the neck, underarm, or groin
- Trouble breathing
- Loud breathing or wheezing
- Night sweats
- Unexplained weight loss
- Trouble swallowing
- Swelling in the head or neck area
- Swelling and pain in the abdomen
The symptoms of AIDS-related lymphoma can be like other health conditions. Make sure your child sees a healthcare provider for a diagnosis.
How is AIDS-related lymphoma diagnosed in a child?
If your child has AIDS, he or she will be checked often for changes, including those that might be signs of AIDS-related lymphoma. Your child's healthcare provider will ask about your child's health history and symptoms. He or she will examine your child. Your child may have tests such as:
- Blood and urine tests. Blood and urine are tested in a lab.
- Tissue and lymph node biopsy. Samples of tissue are taken from the lymph nodes or other body tissue. They’re checked with a microscope for cancer cells.
- Chest X-ray. The chest X-ray shows the heart, lungs, and other parts of the chest.
- CT scan. This may be done for the abdomen, chest, and pelvis. A CT scan uses a series of X-rays and a computer to make detailed pictures of the body.
- MRI scan. An MRI uses large magnets, radio waves, and a computer to make detailed pictures of the body. This test is used to check the brain and spinal cord. Or it may be used if the results of an X-ray or CT scan unclear.
- Ultrasound. This is also called sonography. Sound waves and a computer are used to make pictures of blood vessels, tissues, and organs.
- Positron emission tomography (PET) scan. For this test, a radioactive sugar is injected into the bloodstream. Cancer cells use more sugar than normal cells, so the sugar will collect in cancer cells. A special camera is used to see where the radioactive sugar is in the body. A PET scan can sometimes spot cancer cells in different areas of the body, even when they can’t be seen by other tests. This test is often used in combination with a CT scan. This is called a PET/CT scan.
- Bone marrow aspiration or biopsy. Bone marrow is found in the center of some bones. It’s where blood cells are made. A small amount of bone marrow fluid may be taken. This is called aspiration. Or solid bone marrow tissue may be taken. This is called a core biopsy. Bone marrow is usually taken from the hip bone. This test may be done to see if cancer cells have reached the bone marrow.
- Lumbar puncture. A special needle is placed into the lower back, into the spinal canal. This is the area around the spinal cord. This is done to check the brain and spinal cord for cancer cells. A small amount of cerebral spinal fluid (CSF) is removed and sent for testing. CSF is the fluid around the brain and spinal cord.
- Pleural or peritoneal fluid sampling. Fluid is removed from around the lungs (pleura) or abdomen (peritoneum). The fluid is checked for cancer cells.
Part of diagnosing cancer is called staging. Staging is the process of seeing if the cancer has spread, and where it has spread. Staging also helps to decide the treatment. There are different ways of staging used for NHL. Talk with your child's healthcare provider about the stage of your child's cancer. One method of staging Burkitt lymphoma is the following:
- Stage I. The lymphoma is in only 1 place. It’s either in a lymph node or one other part of the body. It is not in the chest or abdomen.
- Stage II. The lymphoma is in 2 or more places. It’s all in either the upper or lower part of the body. It’s not in the chest.
- Stage III. The lymphoma is in the chest or spine, or it has spread throughout the abdomen. Or it is both in the upper and lower parts of the body, but is not in bone marrow or the brain or spinal cord (central nervous system).
- Stage IV. The lymphoma is in the bone marrow, the brain and spinal cord, or all three when it is first found.
How is AIDS-related lymphoma treated in a child?
Treatment will depend on the type and stage. It will also depend on:
- When your child first received treatment for HIV/AIDS
- If the cancer has spread to the brain or spinal cord
- If there are chromosomal changes in the cancer cells
Treatment may include any of the below:
- Chemotherapy. These are medicines that kill cancer cells or stop them from growing. They may be given into the vein (IV), injected into tissue, or taken by mouth.
- Radiation therapy. These are high-energy X-rays or other types of radiation. They are used to kill cancer cells or stop them from growing.
- Monoclonal antibodies. This is a type of targeted therapy that kills cancer cells without harming healthy cells.
- High-dose chemotherapy with a stem cell transplant. Young blood cells (stem cells) are taken from the child or from someone else. This is followed by a large amount of chemotherapy medicine. This causes damage to the bone marrow. After the chemotherapy, the stem cells are replaced.
- Antibiotic medicines. These help to prevent or treat infections.
- Supportive care. Treatment can cause side effects. Medicines and other treatments can be used for pain, fever, infection, and nausea and vomiting
- Clinical trials. Ask your child's healthcare provider if there are any treatments being tested that may work well for your child.
Treating the HIV infection itself is also an important part of therapy.
Your child will need follow-up care during and after treatment to:
- Check on your child's response to the treatment
- Manage the side effects of treatment
- Look for returning or spreading cancer
What are possible complications of AIDS-related lymphoma in a child?
Possible complications depend on the type and stage of the lymphoma, and can include:
- Increased risk of infection
- Heart disease
- Lung problems
- Increased chance of growing other cancers
- Trouble reproducing (infertility)
Treatment may also cause complications. They include:
- Increased risk of bleeding
- Increased risk of infection
- Nausea and vomiting
- Poor appetite
- Sores in the mouth
- Hair loss
How is AIDS-related lymphoma managed in a child?
You can help your child manage his or her treatment in many ways. For example:
- Your child may have trouble eating. A dietitian may be able to help.
- Your child may be very tired. He or she will need to balance rest and activity. Encourage your child to get some exercise. This is good for overall health. And it may help to lessen tiredness.
- If your child smokes, help him or her quit. If your child doesn’t smoke, make sure he or she knows the danger of smoking.
- Get emotional support for your child. Find a counselor or child support group can help.
- Make sure your child attends all follow-up appointments.
When should I call my child’s healthcare provider?
Call the healthcare provider if your child has:
- Symptoms that get worse
- New symptoms
- Side effects from treatment
Key points about AIDS-related lymphoma in a child
- AIDS-related lymphoma a type of non-Hodgkin lymphoma. It grows in some people with AIDS.
- It may affect the lymphatic system, brain and spinal cord, and other parts of the body.
- Treatment depends on the type, stage, and other factors. It may include chemotherapy, radiation therapy, and stem-cell transplant.
Tips to help you get the most from a visit to your child’s healthcare provider:
- Know the reason for the visit and what you want to happen.
- Before your visit, write down questions you want answered.
- At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
- Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
- Ask if your child’s condition can be treated in other ways.
- Know why a test or procedure is recommended and what the results could mean.
- Know what to expect if your child does not take the medicine or have the test or procedure.
- If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
- Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.
April 18, 2017
Alteri, Rick, MD,MMI board-certified, academically affiliated clinician