AIDS-Related Lymphoma in Children

What is AIDS-related lymphoma in children?

AIDS-related lymphoma is a type of cancer called non-Hodgkin lymphoma (NHL). Childrenwith AIDS have a higher risk forthis cancer. AIDS is a disease that weakens the immune system. AIDS raises the risk for infection and for long-term (chronic) diseases, 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 fight diseases and infections. The lymphatic system also helps balance fluids in different parts of the body. The lymphatic system includes:

• Lymph.This is a clear fluid that contains white bloods cells called lymphocytes.
• Lymph vessels. These are tiny tubes that carry lymph fluid all over the body.
• Lymphocytes. These are a type of white blood cell that fight infections and disease.
• Lymph nodes. These are small bean-shaped organs. They're scattered all over the body. They're connected by lymph vessels.Andthey 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. It also includes the spleen, thymus, tonsils, and digestive tract.

Along with the lymphatic system, AIDS-related lymphoma can affect the brain and spinal cord (central nervous system). It can also affect the lining of body cavities. These include the chest, the belly (abdomen), and the sac containing the heart.

The 2 main types of AIDS-related lymphoma are:

• Diffuse large B-cell lymphoma
• Burkitt lymphoma

Both grow very fast and can grow outside the lymphatic system.

What causes AIDS-related lymphoma in a child?

HIV is the virus that causes AIDS. People are often infected with HIV through contact with the blood or other body fluids of someone with HIV or AIDS. In children, this often 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. This makes it harderfor the immune system to fight cancers and infections. People with AIDS have an increased chance of lymphoma and other types of cancer. They're also at a high risk for infections.

Which children are at risk for AIDS-related lymphoma?

All people with HIV, no matter their age,are at risk forAIDS-related lymphoma.

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 itis. Symptoms may include:

• Swollen, painless lymph nodes in the neck, underarm, or groin
• Trouble breathing
• Loud breathing or wheezing
• Night sweats
• Unexplained weight loss
• Fever with no known reason
• Trouble swallowing
• Swelling in the head or neck
• Swelling and pain in the belly (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 HIV, he or she will be checked often for changes. This includes changes that might be signs of AIDS-related lymphoma. Your child's healthcare provider will ask about your child's health history and symptoms. A physical exam will be done. Your child may need tests such as:

• Blood and urine tests.Blood and urine samples are tested in a lab.
• Tissue and lymph node biopsy. Small tissue samplesare taken from the lymph nodes or other body tissue. They’re checked with a microscope for cancer cells. 
• Chest X-ray. This shows the heart, lungs, and other parts of the chest.
• CT scan.This uses a series of X-rays and a computer to make detailed pictures of the inside of the body. Your child may drink a contrast dye or it may be injected into a vein. The dye helps show more details.
• MRI scan. An MRI uses large magnets, radio waves, and a computer to make detailed pictures of the inside of the body. Contrast dye may be injected into your child's vein. It helps show details more clearly. 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 are not clear. 
• Ultrasound. This is also called sonography. Sound waves and a computer are used to make pictures of lymph nodes, blood vessels, tissues, and organs.
• 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 canbe taken out. This is called aspiration. Or solid bone marrow tissue may be taken. This is called a core biopsy. Bone marrow is often taken from the back of the hip bone. This test may be done to see if cancer cells have reached the bone marrow.
• Lumbar puncture (spinal tap). A thin needle is placed between the bones in the lower back andinto the spinal canal. This is the area around the spinal cord. This is done to see if there are cancer cells in the brain and spinal cord. A small amount of cerebral spinal fluid (CSF) is taken out 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 lungsor the belly. 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 on the best treatment options. There are different staging systems used for NHL.But most range from stage 1 to stage 4. Stage 4 is cancer that has spread to parts of the body that are not part of the lymphatic system. Talk with your child's healthcare provider about the stage of your child's cancer and what it means.

How is AIDS-related lymphoma treated in a child?

Treatment will depend on the type and stage of lymphoma. It will also depend on:

• When your child first had treatment for HIV/AIDS
• If the cancer has spread to the brain or spinal cord
• If there are gene changes in the cancer cells

Treatment may include any of the below:

• Chemotherapy (chemo). These are medicines that kill cancer cells or stop them from growing. This is the main treatment for lymphoma. 
• Radiation therapy. These are high-energy X-rays or other types of radiationused to kill cancer cells.This treatment may be used if lymphoma has spread to the CSF. Or it may be used to treat tumors that are causing problems such as pressing on nerves or breathing tubes.
• Monoclonal antibodies. This is a type of targeted therapy that's made to focus on and kill the cancer cells. It causes littleharm to 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 high doses of chemotherapy.This causes bone marrow damage. After the chemotherapy, the stem cells are replaced.
• Supportive care.Treatment can cause side effects. Supportive care is medicine and other treatments 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. Many new treatments are only available in clinical trials.

Treating the HIV infection itself is also an important part of therapy. Your child will be given antiretroviral treatment (ART) to control the virus.

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
• See if cancer has returned or spread
• Keep the HIV under control

What are the possible complications of AIDS-related lymphoma in a child?

Possible complications depend on the type and stage of the lymphoma, as well as the treatments used. Complications can include:

• Increased risk of infection
• Easy bleeding and bruising
• Heart disease
• Lung problems
• Increased chance of growing other cancers
• Trouble having a baby (infertility)
• Nausea and vomiting
• Diarrhea
• Poor appetite
• Sores in the mouth
• Hair loss

Talk withyour child's healthcare provider about what you should watch for. Also ask what can be done to help prevent complications.

How can I help my child live with AIDS-related lymphoma?

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.
• Get emotional support for your child. Find a counselor or a child support group that can help.
• Make sure your child goes to 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 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.
• Treating the HIV is an important of your child's health.

Next steps

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.