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Large Cell Lymphoma

  • Large cell lymphoma is a type of non-Hodgkin lymphoma. It’s a cancer in the lymphatic system, which is part of the immune system, which works to fight disease and infections. Large cell lymphoma may develop in the lymph system tissue in the neck, chest, throat or abdomen.

    • It can spread to the skin or tissues under the skin. It may also spread to bone marrow and the brain.
    • It’s thought to be caused by genetics and/or exposure to viral infections, radiation or chemotherapy.
    • It accounts for about 30 percent of non-Hodgkin lymphomas in children.
    • It’s more common in Caucasian boys.
    • Treatments may involve a combination of therapies including surgery, radiation, chemotherapy and/or stem-cell transplants.

    How Dana-Farber/Boston Children’s approaches large cell lymphoma

    Patients with large cell lymphoma are treated through Dana-Farber/Boston Children's Cancer and Blood Disorders Center, an integrated pediatric hematology and oncology partnership between Dana-Farber Cancer Institute and Boston Children’s Hospital. Specialists from Boston Children’s Hospital work very closely with the experts at Dana-Farber Cancer Institute to ensure that every aspect of your child’s health is overseen before, during and after his treatment period. Members of Lymphoma Program —specialists in oncology, radiation oncology, surgery, interventional and diagnostic radiology and hematopathology—have specialized expertise in pediatric lymphomas.

    Boston Children's Hospital 
    300 Longwood Avenue (Inpatient)
    44 Binney Street, 3rd Floor (Outpatient)
    Boston MA 02115

    call: 888-PEDI-ONC
    fax: (617) 632-4248

  • What is large cell lymphoma?

    Large cell lymphoma is a type of non-Hodgkin lymphoma. It’s a cancer in the lymphatic system, which is part of the immune system, which works to fight disease and infections. Large cell lymphoma may develop in the lymph system tissue in the neck, chest, throat or abdomen.

    Sometimes, it spreads to the skin or tissues under the skin. It may also spread to bone marrow and the brain.

    Types of large cell lymphoma

    The main subtypes of large cell lymphomas are:

    • non-specified large cell lymphoma
    • immunoblastic lymphoma
    • anaplastic large cell lymphoma (ALCL)

    What causes large cell lymphoma?

    The specific cause of non-Hodgkin lymphoma is unclear. Some theories include:

    • genetics
    • exposure to viral infections such as Epstein-Barr virus and human immunodeficiency virus (HIV)
    • exposure to chemotherapy and radiation therapy
    • hereditary abnormalities including ataxia telangiectasia, X-linked lymphoproliferative disease or the Wiskott-Aldrich syndrome

    Is large cell lymphoma common?

    Large cell lymphoma accounts for about 30 percent of non-Hodgkin lymphomas in children. Non-Hodgkin lymphoma as a group is the third most common childhood cancer.

    • It occurs most often in children who are between the ages of 7 and 11, but can occur at any age from infancy to adulthood.
    • It affects boys almost three times more often than girls.
    • It’s most common among Caucasian children.

    What are the symptoms of large cell lymphoma?

    The disease can progress quickly from a few days to a few weeks. While symptoms may vary child-to-child, the most common include:

    • respiratory problems, pain with deep breaths (dyspnea), cough and/or wheezing
    • abdominal pain
    • constipation
    • painless swelling of the lymph nodes in neck, chest, abdomen, underarm, or groin
    • fever
    • sore throat
    • fullness in groin area from node involvement
    • bone and joint pain
    • night sweats
    • tiring easily (fatigue)
    • weight loss/decreased appetite
    • itching of the skin
    • recurring infections
  • How does a doctor know if it’s large cell lymphoma?

    In addition to a complete medical history and physical examination, diagnostic procedures for Hodgkin lymphoma may include:

    • blood and urine tests
    • x-rays of the chest- a diagnostic test which uses invisible electromagnetic energy beams to produce images of your child’s internal tissues, bones and organs onto film
    • lymph node biopsy - a sample of tissue is removed from a lymph node and examined under a microscope
    • computerized tomography scan (also called a CT or CAT scan)- a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images
    • lymphangiogram (LAG)- dye injected into the lymphatic system to determine how much it is involved in areas that are otherwise difficult to visualize
    • bone marrow biopsy/aspiration - a procedure that involves a small amount of bone marrow fluid and tissue to be taken, usually from part of the hip bones, to examine the number, size, and maturity of blood cells and/or abnormal cells
    • lumbar puncture (to evaluate central nervous system disease for cancer cells) - a special needle placed into your child’s lower back, into the spinal canal
  • Treatment options will vary greatly, depending on your child's situation. Your doctor and other members of your care team will discuss the options with you in-depth. Prompt medical attention and aggressive therapy are important.

    Traditional treatments for large cell lymphoma

    Treatments for large cell lymphomamay involve a combination of therapies including:

    Surgery

    Surgery usually plays a limited role in the treatment of lymphoma. In some instances, a child may need to have a tumor removed. This may be the case if, for example, the tumor compresses the airway and/or the heart and major vessels. Surgery in this area may entail considerable risk, and must be carefully orchestrated between the surgeon, oncologist and anesthesiologist.

    Radiation therapy

    Our doctors use precisely targeted and dosed radiation to kill cancer cells left behind after your child's surgery.

    Chemotherapy

    Chemotherapy is a drug that interferes with the cancer cell's ability to grow or reproduce.

    • Different groups of chemotherapy drugs work in different ways to fight cancer cells and shrink tumors.
    • Often, a combination of chemotherapy drugs is used.
    • Certain chemotherapy drugs may be given in a specific order depending on the type of cancer it is being used to treat.

    While chemotherapy can be quite effective in treating certain cancers, the agents do not differentiate normal healthy cells from cancer cells. Because of this, there can be many adverse side effects during treatment. Being able to anticipate these side effects can help the care team, parents, and child prepare, and, in some cases, prevent these symptoms from occurring, if possible.

    Chemotherapy is systemic treatment, meaning it is introduced to the bloodstream and travels throughout the body to kill cancer cells. Chemotherapy can be given:

    • as a pill to swallow
    • as an injection into the muscle or fat tissue
    • intravenously (IV), directly to the bloodstream
    • intrathecally, directly into the spinal column with a needle

    Stem cell transplant

    Transplantation of normal stem cells from another person is used to help restore normal blood production in you child, whose own ability to make any or all of these blood cells has been compromised by cancer, intensive cancer treatment or other types of damage or abnormality.

    Supportive care

    This is any type of treatment to prevent and treat infections, side effects of treatments, and complications and to keep your child comfortable during treatment.

    What is the recommended long-term care for children treated for large cell lymphoma?

    Children treated for large cell lymphoma should visit a survivorship clinic every year to:

    • manage disease complications
    • screen for early recurrence of cancer
    • manage late effects of treatment

    A typical follow-up visit may include some or all of the following:

    • a physical exam
    • laboratory testing
    • imaging scans

    Through the David B. Perini, Jr. Quality of Life Clinic at Dana-Farber Cancer Institute, childhood cancer survivors receive a comprehensive follow-up evaluation from their cancer care team.

    • Our childhood cancer survivorship clinic is held weekly.
    • In addition to meeting with your pediatric oncologists, your child may see one of our endocrinologists, cardiologists, neurologists, neuro-psychologists or alternative/complementary therapy specialists.
    • We also offer the following services:
      • patient and family education
      • psychosocial assessment
      • genetic counseling
      • reproductive and fertility evaluation and counseling
      • opportunities to speak with other childhood cancer survivors
  • Dana-Farber/Boston Children's is part of the Children's Oncology Group, a national group of pediatric oncologists whose work includes investigational treatments for newly diagnosed patients with non-Hodgkin lymphoma and those who experience relapse. Studies also seek to improve the supportive care of patients undergoing treatment. Learn about our current lymphoma trials and research.

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