non hodgkin's lymphoma

Non-Hodgkin lymphomas



Lymphomas account for 10% of pediatric cancers and are equally shared between Hodgkin and non-Hodgkin lymphomas.
Non-Hodgkin lymphomas bring together different cancers that originate from the lymphoid cells present either in the lymph nodes or in an organ such as the liver, kidney, brain... They can remain localized or disperse to other organs.

These different lymphomas are observed with increased frequency in immunocompromised patients. Rare but classical complication in patients who have received organ transplantation (heart, liver, kidney...) and who take immunosuppressive medications to tolerate the graft, these lymphomas are also seen more often in patients whose Immune defenses are weakened by the AIDS virus. These tumors are extremely susceptible to chemotherapy and their treatment is a great success of pediatric oncology.

Cyril is 5 years old when he consults in November 1999 for a swelling of the angle of the jaw. For 3 months, various antibiotic and anti-inflammatory treatments have been prescribed in the hypothesis of an infectious origin, without success. It is only after two biopsies of this swelling that the final diagnosis of non-Hodgkin's malignant lymphoma is posed. The focus shows that this lymphoma has already metastasized at the liver and kidney level. Cyril was one of 762 patients registered in a study of 161 pediatric cancer centres located in France, Belgium, the Netherlands, Great Britain, the United States and Australia. This was the first protocol for treating a pediatric cancer disease common to Europe and North America. Despite the scarcity of the disease, this intercontinental study is carried out in less than 5 years and, in 2007, the definitive conclusions are published. The results are excellent with a cure rate of 90%. However, the potential toxicity of this chemotherapy to cardiac tissue and fertility remains a concern, and it is a less toxic treatment regimen that will be retained for the new study initiated in 2001 that would benefit the doll.

She was born HIV positive; The virus was transmitted to him by her mother who was infected by her husband. From the age of 6 months, the child is put under anti-HIV treatment. At 16, she consults for large lymph nodes at the neck level. Is it an infection, diagnosis envisaged from the outset because the most common?

Tests are carried out that do not support this hypothesis. The lymph nodes persist and increase in volume. Two months after the first consultation, a surgically removed ganglionic fragment is analyzed and the diagnosis of lymphoma is evoked. This diagnosis will be definitively retained after a second biopsy carried out 1 month later. The disease extension balance also highlights large thoracic ganglia. She is treated for four months according to a classical protocol.

Anti-HIV treatment is suspended during the duration of chemotherapy to limit cumulative toxicity. Despite a significant increase in the detection of the virus in the blood during the interruption of tritherapy, she will not show any complications associated with HIV. The resumption of antiviral treatment at the end of chemotherapy will again be accompanied by a seronegative result.