^{Dr Mohd Haris Fadzillah Bin Abdul Rahman (Left) and Dr Kogilavani Gunasagaran (Right)} 


KUALA LUMPUR, Sept 15 (Bernama) -- Does your child have a persistent lump, unexplained fever or unusual tiredness? Lymphoma is unlikely to be the first thing that comes to a parent’s mind because these symptoms can be caused by common childhood illnesses. However, when symptoms persist, parents may wonder whether something more serious could be going on.
 
Lymphoma can affect both adults and children, but it does not necessarily behave in the same way across age groups, and neither is it treated with a one-size-fits-all approach. So, what does lymphoma look like in a child, how has treatment changed, and what could the future of childhood lymphoma care look like?
 
In conjunction with World Lymphoma Awareness Month, Dr Mohd Haris Fadzillah Bin Abdul Rahman, Consultant Physician and Haematologist at Subang Jaya Medical Centre (SJMC) and President of Malaysian Society of Haematology, and Dr Kogilavani Gunasagaran, Consultant Paediatrician and Paediatric Haematologist & Oncologist at SJMC, will be shedding light on Childhood Lymphoma within this article.
 
1. Adult vs Childhood Lymphoma
One of the most important things to understand about lymphoma is that it is not a single disease. There are many different types, and the pattern of lymphoma seen in children can be quite different from that seen in adults.
 
“In children, lymphoma is more commonly made up of fast-growing, aggressive subtypes, including lymphoblastic lymphoma, Burkitt lymphoma and anaplastic large-cell lymphoma. Hodgkin lymphoma is also an important type of lymphoma, particularly among adolescents and young people.”
 
“In adults, the range of lymphoma is broader. Alongside aggressive forms such as diffuse large B-cell lymphoma, adults can also develop slower-growing or indolent lymphomas, such as follicular lymphoma, which is uncommon in children. Other types, including mantle cell lymphoma and several mature B-cell lymphomas, are also seen predominantly in older adults,” shared Dr Haris.
 
These differences are not simply a matter of age. Children are not small adults. The biology and developmental origins of lymphoma can differ across the age spectrum, including the genetic changes that drive the disease. This is why doctors need to establish exactly what type of lymphoma a patient has before deciding how best to treat it.

2. Treatment Is Becoming More Personalised
For many parents, hearing the word lymphoma may immediately bring chemotherapy to mind. And for good reason: multi-agent chemotherapy remains an important part of treatment for many lymphomas, particularly the fast-growing types commonly seen in children. These cancers can be highly sensitive to chemotherapy, which means treatment can be very effective.
 
But chemotherapy is no longer the only tool doctors have. Over the past few decades, doctors have gained a much better understanding of what makes different lymphomas grow and survive. This has opened the door to treatments that can recognise specific features of the cancer or harness the body's own immune system to fight it.
 
For children, the goal of treatment extends far beyond achieving remission today. “Children have a much longer life expectancy after treatment. Therefore, doctors need to consider not only curing the lymphoma today, but also the patient's health 10, 20 or 50 years later. In paediatric oncology, survival alone is no longer enough. The goal is increasingly to achieve a cure while minimising the long-term impact of treatment,” said Dr Kogilavani.
 
Treatments for childhood lymphoma include:
- Monoclonal antibodies
Monoclonal antibodies can be thought of as specially designed proteins that recognise particular "markers" found on cancer cells. For example, Rituximab targets a marker called CD20, which is found on many B-cell lymphomas. When appropriate, it can be added to chemotherapy to improve the effectiveness of treatment.

- Targeted Therapy
Rather than broadly attacking rapidly dividing cells, these medicines interfere with particular signals or processes that lymphoma cells rely upon to survive and grow. Different lymphoma subtypes may have different vulnerabilities, so these treatments can increasingly be selected according to the biology of the disease.

- Immunotherapy
Immunotherapy works in different ways, but the basic idea is to help the immune system recognise and attack cancer cells. One newer approach is bispecific antibodies - the medicine acts like a bridge: one end attaches to the lymphoma cell, while the other attaches to an immune cell called a T-cell. By bringing the two cells together, the treatment helps the immune system target the lymphoma.

- Stem cell transplantation
For some patients whose lymphoma returns or is particularly difficult to treat, stem cell transplantation may also be considered. In one common approach, a patient's own blood-forming stem cells are collected and stored before intensive chemotherapy is given. The stem cells are then returned to the patient to help the bone marrow recover; this is called autologous transplantation.

- CAR-T cell therapy
This is an emerging cellular therapy for childhood lymphoma, in which a patient’s own T cells are collected and modified in a specialised laboratory so that they can recognise a specific marker on lymphoma cells. These modified immune cells are then returned to the patient, where they can seek out and attack the lymphoma cells.
 
“The important message is that these newer treatments do not simply replace chemotherapy. Instead, we now have a much larger treatment toolbox. Depending on the lymphoma and the patient, treatment may involve a combination of different approaches,” added Dr Haris.
 
3. Advantages of targeted therapy and immunotherapy for childhood lymphoma
Targeted therapy uses medicines designed to block specific features that help lymphoma cells grow and survive. Advantages include:

1. Instead of broadly attacking rapidly dividing cells, targeted therapy focuses on specific weaknesses in the lymphoma cells.

2. Because the treatment is more targeted, it may reduce some of the effects on healthy cells associated with conventional chemotherapy.

3. Genetic and molecular testing can help doctors identify patients whose lymphoma has specific features that can be targeted with certain medicines.

4. Importantly for children, targeted approaches may eventually allow some patients to achieve the same cure rate with less conventional chemotherapy.
 
Immunotherapy works by helping the body's own immune system recognise and fight lymphoma cells. Advantages include:

1. The immune system can potentially continue to attack lymphoma cells even after the treatment has been given.

2. Some immunotherapies can help keep the lymphoma under control for a longer period, particularly in certain cases where the lymphoma has returned.

3. Some cellular therapies can train or modify the patient's immune cells to recognise and attack lymphoma cells, although how this works varies depending on the treatment.
 
In the longer term, combinations of immune and targeted therapies may allow chemotherapy to be reduced or omitted in selected patients.
 
4. Prognosis for today and future childhood lymphoma treatments
The prognosis for many children with lymphoma today is highly encouraging, although it varies depending on the lymphoma subtype, stage, molecular characteristics, response to treatment and whether the disease returns.
 
“Childhood Hodgkin lymphoma has one of the highest cure rates in paediatric oncology, with around 90–95% of children and adolescents able to be cured. For childhood and adolescent non-Hodgkin lymphoma, five-year relative survival was around 90% between 2013 and 2019, although outcomes vary between subtypes and risk groups,” said Dr Kogilavani.
 
These improvements have been driven by better disease classification, risk- and response-adapted treatment, multidisciplinary care and advances in supportive care.
 
Looking ahead, advances in genomic and molecular testing, targeted therapies, immunotherapy, cellular therapy and better monitoring could make treatment even more personalised. The goal is not simply to cure more children, but to achieve a cure with fewer long-term effects and a better quality of life.
 
For more information about SJMC’s Cancer Care treatments, please contact our Cancer Care Coordinator: +6019-218 3595 / +6019-628 4130 


SOURCE: Subang Jaya Medical Centre (SJMC)

FOR MORE INFORMATION, PLEASE CONTACT:
Cancer Care Coordinator
Tel: +6019-218 3595 / +6019-628 4130 

--BERNAMA