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Lymphoma of Bone

  • Pediatric lymphoma of bone is a type of non-Hodgkin lymphoma, a cancer in the lymphatic system. The lymphatic system is part of the immune system, and works to fight disease and infections. Lymphoma of bone is considered to be a widespread disease, because usually multiple sites in the body are involved as primary sites. In some children however, the tumor may arise in the bone only.

    Characteristics of pediatric lymphoma 

    Lymphoma of bone tends to spread to the other organs and tissues in the body.

    It’s thought to be caused by genetics and/or exposure to viral infections, radiation, or chemotherapy.

    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 Cancer and Blood Disorders Center approaches pediatric lymphoma of bone

    Patients with lymphoma of the bone 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. We utilize the expertise of both Boston Children’s Hospital and Dana-Farber Cancer Institute and all members of our physician team — from Oncology, Radiation Oncology, Surgery, Interventional and Diagnostic Radiology and Hematopathology — have expertise in treating pediatric lymphomas. Your child will also have access to unique Phase I clinical trials, from our own childhood cancer research investigators, and from the Children’s Oncology Group.

    Boston Children's Hospital
    300 Longwood Ave
    Fegan 2
    Boston MA 02115

    617-355-6021
    fax: 617-730-0456

  • What is lymphoma of bone?

    Lymphoma of bone is a type of non-Hodgkin lymphoma, a cancer in the lymphatic system. The lymphatic system is part of the immune system, and works to fight disease and infections. Lymphoma of bone is considered to be a widespread disease, because usually multiple sites in the body are involved as primary sites. In some children however, the tumor may arise in the bone only.

    What causes lymphoma of bone?

    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 such as ataxia telangiectasia, X-linked lymphoproliferative disease, or the Wiskott-Aldrich syndrome

    Is lymphoma of bone common?

    Non-Hodgkin lymphoma as a group is the third most common childhood cancer. More specifically it:

    • occurs most often in children between the ages of 7 and 11, but can occur at any age from infancy to adulthood
    • affects boys almost three times more often than girls
    • is more common among Caucasian children than among African-American children and children of other races

    What are the symptoms of lymphoma of bone?

    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 that if my child has lymphoma of bone?

    In addition to a complete medical history and physical examination, diagnostic procedures for lymphoma in the bone 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 is injected into 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 further 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 is placed into your child’s lower back, into the spinal canal and a small amount of cerebral spinal fluid is removed
  • Treatment options will vary greatly, depending on your child's situation. Your child's doctor and other members of your care team will discuss the options with you in-depth. Prompt medical attention and aggressive therapy are important for the best prognosis. Side effects of radiation and chemotherapy, as well as recurrence of the disease, can occur in survivors.

    Traditional treatments for lymphoma of bone

    Treatments for lymphoma of bone may 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.

    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, it affects both normal healthy cells and cancer cells. Because of this, there can be many side effects during treatment. Being able to anticipate these side effects can help you and your 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

    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 lymphoma of bone?

    Children treated for lymphoma of bone 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

    Beading Each a Different Story

    Unless you're a survivor, it's impossible to understand the relentless challenges of cancer treatment. In addition to hurdles like chemotherapy sessions, patients must also endure a constant barrage of uncomfortable tests and procedures. For children, the incessant poking and prodding can become overwhelming. To help young patients treated through Dana-Farber/Boston Children’s Cancer and Blood Disorders Center stay positive and face future treatments, resource room and Child Life Specialists Ingrid Dahlin, Sara Mastrofrancesco, Summer Menefee and Amber Soulvie of Boston Children's Hospital, Julie Gauguet of Brigham and Women's Hospital and Martha Young of Dana-Farber, created Beading Each a Different Story (BEADS).

    BEADS offers children a special glass bead for achieving a treatment milestone. For example, a yellow sun represents a radiation session, while a smiley face sporting a bandana signifies hair loss. When strung together, patients have a visual record of their cancer journey. More than 100 patients have participated in BEADS since its September launch, and its impact is visible. "They really feel like badges of courage," says Jennifer Kisiel, whose 6-year-old daughter, Rebecca, was recently diagnosed with acute lymphoblastic leukemia. "Rebecca's string validates what she's endured."

  • Dana-Farber/Boston Children's is part of the Boston 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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