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Lymphoma in children 2021
This document discusses pediatric oncology, specifically lymphoma in children. It begins with definitions of lymphoma and its types. Hodgkin lymphoma is more common in older children while non-Hodgkin lymphoma occurs more in younger children. The document describes the histology, clinical features, investigations, differential diagnosis, supportive treatment and chemotherapy-based management of Hodgkin and non-Hodgkin lymphoma in children. The goal of treatment is to cure the disease using multi-agent chemotherapy regimens tailored to the specific lymphoma type and stage.
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Lymphoma in children 2021
- 1. Pediatric Oncology Classification, Epidemiology,Clinical Features, Prognosis Prof. Imran Iqbal Fellowship in Pediatric Neurology (Australia) Prof of Paediatrics (2003-2018) Prof of Pediatrics Emeritus, CHICH Prof of Pediatrics, CIMS Multan, Pakistan
- 2. It contains estimated200 Billion Stars, the sun lies roughly 27,000 light-years from the centre of the galaxy. And there are estimated minimum 100 Billion Galaxies in the Universe.
- 3. (God speaking toProphet Muhammad (PBUH) And (remember) Ayub (Job), when he called his Lord saying “I have been afflicted by distress (disease), and You are the most merciful of all those who have mercy” The Holy Quran; surah Al-Anbiya 21:83 In the name of Our Creator Allah, the most Gracious, the most Merciful
- 4. Pediatric Oncology -Epidemiology • Malignancies are one of the leading causes of death in children under 15 years of age • It is estimated that approximately 7500- 8000 children less than 18 years get cancer, every year in Pakistan.
- 5. Pediatric Oncology –Types of Malignancies Pakistan Data Disease Percentage Leukemia 35 Lymphoma 20 Bone Tumor 08 Soft Tissue Sarcoma 07 Brain Tumor 07 Retinoblastoma 06 Neuroblastoma 04 Wilms Tumor 04 Germ Cell Tumor 03 Others 06
- 7. Pediatric Oncology Lymphoma inChildren Classification, Epidemiology, Clinical Features, Diagnosis, Complications, Management Prof. Imran Iqbal Fellowship in Pediatric Neurology (Australia) Prof of Paediatrics (2003-2018) Prof of Pediatrics Emeritus, CHICH Prof of Pediatrics, CIMS Multan, Pakistan
- 8. Lymphoma Definition • Lymphoma isan uncontrolled malignant proliferation of Lymphoid cells • Lymphoid cells are found in primary lymph organs and secondary lymph organs • Primary lymph organs – Bone marrow (B - cells) and Thymus (T - cells) • Secondary lymph organs – Lymph nodes, Spleen, and Mucosa-associated lymphoid tissue (MALT).
- 9. Lymphoma Types • Hodgkin lymphoma– HL (Reed-Sternberg cells) • Non-Hodgkin lymphoma – NHL
- 10. Lymphoma Epidemiology • Hodgkin lymphoma– HL • Common Age = 10 – 20 years • Slow growing in months to years • Non-Hodgkin lymphoma – NHL • Common Age = 5 - 10 years • Fast growing in weeks to months
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- 12. Hodgkin Lymphoma Histology • Hodgkinlymphoma – HL • Lymphocyte Predominance – 30 % • Lymphocyte Depletion – 10 % • Mixed cellularity – 50 % • Nodular Sclerosis – 10 %
- 13. Non - HodgkinLymphoma Histology • Non - Hodgkin lymphoma – NHL • Burkitt Lymphoma (B-cell) – 50 % • Lymphoblastic Lymphoma (T-cell) – 15 % • Diffuse Large Cell Lymphoma (B-cell) – 30 %
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- 15. Hodgkin Lymphoma Clinical Features •Lymph node enlargement – (Cervical, Axillary, Abdominal) • Fever • Weight loss • Night sweats • Anemia • Hepatosplenomegaly
- 16. Non-Hodgkin Lymphoma Clinical Features •Abdominal mass • Mediastinal mass • Jaw swelling • Fever • Weight loss • Anemia
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- 18. Hodgkin Lymphoma Differential Diagnosis •Acute lymphadenitis • Chronic lymphadenitis • Tuberculosis
- 19. Non - HodgkinLymphoma Differential Diagnosis • Tuberculosis • Neuroblastoma (abdomen) • Rhadomyosarcoma
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- 21. Hodgkin Lymphoma Investigations • CBC,ESR, CRP • LFT, RPM, LDH, Uric acid • Coagulation profile • US abdomen • X-ray Chest • CT scan Thorax / Abdomen • Bone Marrow Biopsy • Lymph Node Biopsy - Histopathology
- 22. Non – HodgkinLymphoma Investigations • CBC, ESR, CRP • LFT, RPM, LDH, Uric acid • Coagulation profile • US abdomen • X-ray Chest • CT scan Thorax / Abdomen • Bone Marrow Biopsy • Tissue Biopsy - Histopathology
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- 24. Lymphoma Supportive Treatment • Bloodcomponent transfusions (Packed RBCs, Platelets) • Neutrophil stimulation factors (GM-CSF for neutropenia) • Antibiotics – for prophylaxis and treatment of infections • Anti-emetics – for chemotherapy induced emesis • Tumor Lysis Syndrome – fluids, allopurinol • Nursing Care – IV sites, mouth, skin • Nutritional support – High calorie, palatable diet • Psychosocial support – Patients and families
- 25. Hodgkin Lymphoma Management • Managementis done in specific centres • Multi-agent cytotoxic chemotherapy is given in the form of monthly cycles • ABVD (Adriamycin, Bleomycin, Vinblastine, Dacarbazine) • COPP (Cyclophosphamide, Vincristine, Procarbazine, Prednisolone) • Total duration is 6 – 12 months
- 26. Non – HodgkinLymphoma Management • Management is done in specific centres • Multi-agent cytotoxic Chemotherapy is given • Cyclophosphamide, Vincristine, Daunorubicin, Asparaginase, Methotrexate, Prednisolone are commonly used • Dissemination of Lymphoblastic cells to blood (Acute Lymphoblastic Leukemia) can occur • Prognosis depends on histology and stsging of disease