Pediatric Non-Hodgkin Lymphoma: A Retrospective 7-Year Experience in Children & Adolescents with Non-Hodgkin Lymphoma Treated in King Fahad Medical City (KFMC)


Background: Non-Hodgkin’s lymphoma is an aggressive malignant disease in children and adolescents. Although it is the fourth most common malignancy in Saudi children as reported in Saudi cancer registry, less information is available about pediatric Non-Hodgkin lymphoma and its outcome in Saudi Arabia. Study Objectives: To provide demographic data, disease characteristics, treatment protocol, toxicity and outcome of treatment in children & adolescents with Non-Hodgkin’s lymphoma treated at KFMC. This study will form base line for future studies about pediatric Non-Hodgkin’s lymphoma in KFMC, which may help to improve outcome for children with cancer in Saudi Arabia. Study Patients and Method: We retrospectively analyzed 28 children and adolescents diagnosed to have Non-Hodgkin’s lymphoma at KFMC between December 2006 and December 2013, followed-up through June 2014. Results: Of the 28 patients, 10 (35.7%) girls and 18 (64.3%) boys, the male-to-female ratio was 1.8; 1. The median age at time of diagnosis was 6.4 years old (range 2.0 to 13.0 years old). The majority of patients (64.3%) were aged between 5 and 12 years old. Burkitt’s lymphoma BL/BLL was the most common pathological subtype (60.7%), and DLBCL was the second most common subtype (21.4%). Abdominal and Retroperitoneal involvement was the most common primary site (78.6%) including the ileocaecal region. Most of the children presented with advanced Stage III and IV (75%), Cytogenetic study which screens specifically for the t (8; 14) (q24; q32) a characteristic genetic feature of Burkitt’s Lymphoma was obtained from 21 patients, variant rearrangement was observed in 3/21 samples and complex chromosomes karyotype in addition to IGH/MYC rearrangement was observed in 2/21 samples. Those patients presented with very aggressive lymphoma and combined BM and CNS involvement. We use the French-American-British Mature B-Cell Lymphoma 96 Protocol (FAB LMB 96) for treatment fornewly diagnosed Mature B-Cell type NHL and high risk ALL CCG 1961 Protocol for lymphoblastic lymphoma and international Anaplastic Large Cell Lymphoma 99 Study Protocol for ALCL. The median follow-up in patients not experiencing an adverse event was 53.1 months. The estimated 3-year EFE and OS rates in the entire cohort of patients with newly diagnosed NHL treated in the KFMC were 85.2% and 89.2% respectively; Overall survival (OS) rate of patients with mature B-cell-NHL was 88.9%. Conclusion: The outcomes and survival in our small series appeared to be excellent compared with those reported in other international trials even though most of our patients presented in advanced stage of the disease. We feel that the importance of the current study is to document the relative distribution of various types of pediatric non-Hodgkin’s lymphomas and age-specific distribution in different Histological subtypes.

Share and Cite:

Mobark, N. , Tashkandi, S. , Shakweer, W. , Saidi, K. , Fataftah, S. , Nemer, M. , Alanazi, A. , Rayis, M. , Ballourah, W. , Mosleh, O. , Ullah, Z. , Manjomi, F. and Harbi, M. (2015) Pediatric Non-Hodgkin Lymphoma: A Retrospective 7-Year Experience in Children & Adolescents with Non-Hodgkin Lymphoma Treated in King Fahad Medical City (KFMC). Journal of Cancer Therapy, 6, 299-314. doi: 10.4236/jct.2015.64033.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] The Saudi Cancer Registry (SCR).
[2] Perkins, S.L., Segal, G.H. and Kjeldsberg, C.R. (1995) Classification of Non-Hodgkin’s Lymphomas in Children. Seminars in Diagnostic Pathology, 12, 303-313.
[3] Atra, A., Gerrard, M., Hobson, R., Imeson, J.D., Ashley, S. and Pinkerton, C.R. (1998) Improved Cure Rate in Children with B-Cell Acute Lymphoblastic Leukemia (B-ALL) and Stage IV B-Cell Non-Hodgkin’s Lymphoma (B-NHL): Results of the UKCCSG 9003 Protocol. British Journal of Cancer, 77, 2281-2285.
[4] Bowman, W.P., Shuster, J.J., Cook, B., Griffin, T., Behm, F., Pullen, J., et al. (1996) Improved Survival for Children with B-Cell Acute Lymphoblastic Leukemia and Stage IV Small Non Cleaved-Cell Lymphoma: A Pediatric Oncology Group Study. Journal of Clinical Oncology, 14, 1252-1261.
[5] Brecher, M.L., Schwenn, M.R., Coppes, M.J., Bowman, W.P., Link, M.P., Berard, C.W., et al. (1997) Fractionated Cyclophosphamide and Back to Back High Dose Methotrexate and Cytosine Arabinoside Improves Outcome in Patients with Stage III High Grade Small Non-Cleaved Cell Lymphomas (snccl): A Randomized Trial of the Pediatric Oncology Group. Medical and Pediatric Oncology, 29, 526-533.<526::AID-MPO2>3.0.CO;2-M
[6] Cairo, M.S., Gerrard, M., Sposto, R., Auperin, A., Pinkerton, C.R., Michon, J., et al. (2007) Results of a Randomized International Study of High-Risk Central Nervous System B Non-Hodgkin Lymphoma and B Acute Lymphoblastic Leukemia in Children and Adolescents. Blood, 109, 2736-2743.
[7] Anon (2000) Cuneo, a Classification of B-cell Non-Hodgkin’s Lymphomas (NHL). Atlas of Genetics and Cytogenetics in Oncology and Haematology, 4, 24-26.
[8] Dave, B.J., Nelson, M. and Sanger, W.G. (2011) Lymphoma Cytogenetic. Clinics in Laboratory Medicine, 31, 725-761.
[9] Harris, N.L., Jaffe, E.S., Stein, H., Banks, P.M., Chan, J.K.C., Cleary, M.L., et al. (1994) A Revised European-American Classification of Lymphoid Neoplasms: A Proposal from the International Lymphoma Study Group. Blood, 84, 1361-1392.
[10] Murphy, S.B. (1980) Classification, Staging and End Results of Treatment of Childhood Non-Hodgkin’s Lymphomas: Dissimilarities from Lymphomas in Adults. SeminOncol, 7, 332-339.
[11] Cairo, M.S., Sposto, R. Gerrard, M., Auperin, A., Goldman, S.C., Harrison, L., et al. (2012) Advanced Stage, Increased Lactate Dehydrogenase, and Primary Site, but Not Adolescent Age ( ≥15 Years), Are Associated with an Increased Risk of Treatment Failure in Children and Adolescents with Mature B-Cell Non-Hodgkin’s Lymphoma: Results of the FAB LMB 96 Study. Journal of Clinical Oncology, 30,387-393.
[12] Reiter, A., Schrappe, M., Tiemann, M., Ludwig, W.D., Yakisan, E., Zimmermann, M., et al. (1999) Improved Treatment Results in Childhood B-Cell Neoplasms with Tailored Intensification of Therapy: A Report of the Berlin-Frankfurt-Munster Group Trial NHL-BFM 90. Blood, 94, 3294-3306.
[13] Yaqo, R.T., Hughson, M.D., Sulayvani, F.K. and Al-Allawi, N.A. (2011) Malignant Lymphoma in Northern Iraq: A Retrospective Analysis of 270 Cases According to the World Health Organization Classification. Indian Journal of Cancer, 48, 446-451.
[14] Lowe, E.J. and Gross, T.G. (2013) Anaplastic Large Cell Lymphoma in Children and Adolescents. Paediatric Hematology-Oncology, 30, 509-519.
[15] Mwanda, W.O., Orem, J., Remick, S.C., Rochford, R., Whalen, C. and Wilson, M.L. (2005) Clinical Characteristics of Burkitt’s Lymphoma from Three Regions in Kenya. East African Medical Journal, 82, S135-S143.
[16] Ray, S.1., Mallick, M.G. and Pal, P.B., Choudhury, M.K., Bandopadhyay, A. and Guha, D. (2008) Extranodal Non-Hodgkin’s Lymphoma Presenting as an Ovarian Mass. Indian Journal of Pathology and Microbiology, 51, 528-530.
[17] Miyazaki, N., Kobayashi, Y., Nishigaya, Y. Momomura, M., Matsumoto, H. and Iwashita, M. (2013) Burkitt Lymphoma of the Ovary: A Case Report and Literature Review. Journal of Obstetrics and Gynaecology Research, 39, 1363-1366.
[18] El-Hazmi, M.A.F. and Warsy, A.S. (1999) The Pattern for Common Anaemia among Saudi Children. Journal of Tropical Pdiatrics, 45, 221-225.
[19] Jiang, F., Yu, W.-J., Wang, X.-H., Tang, Y.-T., Guo, L. and Jiao, X.-Y. (2014) Regulation of Hepcidin through GDF-15 in Cancer-Related Anaemia. Clinica Chimica Acta, 428, 14-19.
[20] Al Sudairy, R., Al Omari, A., Jarrar, M., Al Harbi, T., Al Jamaan, K., Tamim, H. and Jazieh, A.R. (2011) Complementary and Alternative Medicine Use among Pediatric Oncology Patients in a Tertiary Care Center, Riyadh, Saudi Arabia. Journal of Clinical Oncology, 29, Article ID: e13011.
[21] Spreafico, F., Massimino, M., Luksch, R., Casanova, M., Cefalo, G.S., Collini, P., et al. (2002) Intensive, Very Short-Term Chemotherapy for Advanced Burkett’s Lymphoma in Children. Journal of Clinical Oncology, 20, 2783-2788.
[22] Patte, C., Auperin, A., Gerrard, M., Michon, J., Pinkerton, R., Sposto, R., et al. (2007) Results of the Randomized International FAB/LMB96 Trial for Intermediate Risk B-Cell Non-Hodgkin Lymphoma in Children and Adolescents: It Is Possible to Reduce Treatment for the Early Responding Patients. Blood, 109, 2773-2780.
[23] Patte, C., Auperin, A., Michon, J., Behrendt, H., Leverger, G., Frappaz, D., et al. (2001) The Société Francaise d'Oncologie Pédiatrique LMB89 Protocol: Highly Effective Multiagent Chemotherapy Tailored to the Tumor Burden and Initial Response in 561 Unselected Children with B-Cell Lymphomas and L3 Leukemia. Blood, 97, 3370-3379.
[24] Anderson, J.R., Jenkin, R.D., Wilson, J.F., Kjeldsberg, C.R., Sposto, R., Chilcote, R.R., et al. (1993) Long-Term Follow-Up of Patients Treated with COMP Or LSA2L2 Therapy for Childhood Non-Hodgkin’s Lymphoma: A Report of CCG-551 from the Children’s Cancer Group. Journal of Clinical Oncology, 11, 1024-1032.
[25] Anderson, J.R., Wilson, J.F., Jenkin, D.T., Meadows, A.T., Kersey, J., Chilcote, R.R., et al. (1983) Childhood Non-Hodgkin’s Lymphoma: The Results of a Randomized Therapeutic Trial Comparing a 4-Drug Regimen (COMP) with a 10-Drug Regimen (LSA2-L2). The New England Journal of Medicine, 308, 559-565.
[26] Lones, M.A., Perkins, S.L., Sposto, R., Kadin, M.E., Kjeldsberg, C.R., Wilson, J.F., et al. (2000) Large Cell Lymphoma Arising in the Mediastinum in Children and Adolescents Is Associated with an Excellent Outcome: A Children’s Cancer Group Report. Journal of Clinical Oncology, 18, 3845-3853.
[27] Percy, C.L., Smith, M.A., Linet, M., et al. (1999) Lymphomas and Reticuloendothelial Neoplasms. In: Ries, L.A.G., Smith, M.A., Gurney, J.G., et al., Eds., Cancer Incidence and Survival among Children and Adolescents: United States SEER Program 1975-1995, National Cancer Institute, Bethesda, Seer Program, NIH Pub. No. 99-4649, 35-50.
[28] Cairo, M.S., Krailo, M.D., Morse, M., Hutchinson, R.J., Harris, R.E., Kjeldsberg, C.R., et al. (2002) Long Term Follow-Up of Short Intensive Multiagent Chemotherapy without high-Dose Methotrexate (“Orange”) in Children with Advanced Non-Lymphoblastic Non-Hodgkin’s Lymphoma: A Children’s Cancer Group Report. Leukemia, 16, 594-600.
[29] Cairo, M.S., Sposto, R., Perkins, S.L., Meadows, A.T., Hoover-Regan, M.L., Anderson, J.R., et al. (2003) Burkitt’s and Burkitt-Like Lymphoma in Children and Adolescents: A Review of the Children’s Cancer Group Experience. British Journal of Haematology, 120, 660-670.
[30] Gerrard, M., Cairo, M.S., Weston, C., Auperin, A., Pinkerton, R., Lambilliote, A., et al. (2008) Excellent Survival Following Two Courses of COPAD Chemotherapy in Children and Adolescents with Resected Localized B-Cell Non-Hodgkin’s Lymphoma: Results of the FAB/LMB 96 International Study. British Journal of Haematology, 141, 840-847.

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.