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AIDS-Related Lymphoma in Children

AIDS-related lymphoma is a type of cancer that develops in some people with AIDS. AIDS is a disease that weakens the immune system and raises the risk for chronic illnesses such as cancer.

Illustration of the immune system
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A type of blood cancer, AIDS-related lymphoma starts in the white blood cells in the lymph system, part of the body's immune system that helps defend against illness and infection. The disease allows cancer cells to flourish in the lymph system.

Lymphomas can be divided into two types: non-Hodgkin lymphoma and Hodgkin lymphoma. Non-Hodgkin lymphoma is much more common in people with AIDS, and when it occurs, it's typically called AIDS-related lymphoma.

Facts about AIDS-related lymphoma

People usually contract AIDS from exposure to bodily fluids of a person infected with HIV. In children, HIV is usually contracted from their mother during childbirth or from breastfeeding. More than 3 million children worldwide are living with HIV, and all of these children are at risk of developing AIDS-related lymphoma.

AIDS in children is most prevalent in sub-Saharan Africa, where about 90 percent of all children with HIV/AIDS live. HIV/AIDS in children, along with AIDS-related lymphoma in children, is much rarer elsewhere, where mother-to-child transmission of HIV is more successfully prevented and treated.

AIDS-related lymphomas can occur in three general areas of the body:

  • Systemic. Lymphoma cells are located in the body from the neck down, including lymph nodes, the spleen, and other organs.

  • Central nervous system. Lymphoma cells are in the central nervous system, including the spinal cord, brain, and lining of the brain.

  • Effusion. Lymphoma cells are contained within a layer of fluid spreading along body membranes.

Doctors have identified three primary types of AIDS-related lymphomas:

  • Diffuse large B-cell lymphoma. This is the most common type of non-Hodgkin lymphoma. It is particularly aggressive and can also develop outside the lymph system.

  • B-cell immunoblastic lymphoma.  This type of lymphoma originates from cancerous changes among B cells in the lymph tissues.

  • Small non-cleaved cell lymphoma. Also called Burkitt lymphoma, this type of fast-growing lymphoma accounts for most childhood cancers in Africa.

Symptoms

AIDS-related lymphoma tends to be a rapidly progressing, aggressive cancer. In children, it can cause a number of symptoms:

  • Swollen, though usually painless lymph nodes in the neck, underarm, or groin

  • Difficulty breathing

  • Loud breathing or wheezing

  • Sweating at night

  • Unexplained weight loss and fever

  • Difficulty swallowing

  • Swelling in the head or neck area

Diagnosis

Children with AIDS can be monitored for the symptoms of AIDS-related lymphoma. Diagnostic tests may include:

  • Physical exam and medical history

  • X-ray of the chest

  • Imaging tests, such as a CT scan

  • Biopsy

  • Laboratory analysis of tissues

  • Examination of body tissues using a scope

Treatment

Treatment for AIDS-related lymphoma depends on the child and the specific type of the disease—some AIDS-related lymphomas are fast growing and others progress slowly. The care a child receives often depends on where he or she lives; children in Africa are far less likely to receive lifesaving treatments than children in developed countries.

Options for treatment usually depend on how advanced the cancer is, where the cancer has spread, and the child's overall health. Other factors include when the child first received treatment for AIDS, whether the cancer has spread to the central nervous system (the brain or spinal cord), and any chromosomal changes noted in the cancerous cells.

Chemotherapy drugs, radiation therapy, and stem cell transplants are all used for treatments; these may also be used in combination. New targeted therapies are being developed, some of which are available only in clinical trials. One of those being studied involves monoclonal antibodies, or proteins that attach to tumor cells to destroy them or keep them from growing or spreading.