B Symptoms in Pediatric Lymphoma
B symptoms in pediatric lymphoma consist of three specific constitutional symptoms: fever, unexplained/unintentional weight loss, and night sweats (profuse or drenching). 1, 2, 3
Definition and Clinical Significance
B symptoms are constitutional symptoms that indicate more advanced disease and higher tumor burden in pediatric patients with lymphoma. 2, 3 The NCCN defines these as:
- Fever - documented temperature elevations 1
- Unexplained/unintentional weight loss - significant weight loss without other cause 1, 2
- Night sweats - specifically profuse or drenching night sweats 2, 3
These symptoms occur more commonly in advanced disease stages and are important prognostic indicators used in risk stratification. 2, 3
Clinical Context
Presentation Patterns
- B symptoms are part of the initial workup and staging evaluation for all pediatric lymphomas 1
- They are documented as part of the essential clinical assessment alongside physical examination, performance status, and laboratory studies 1
- Patients may also present with other symptoms including fatigue, bone pain, irritability, and painless lymphadenopathy, but these are not classified as B symptoms 1
Disease Burden Correlation
B symptoms correlate with higher disease burden and more advanced stage disease. 2, 3 In pediatric Hodgkin lymphoma specifically, B symptoms are associated with:
- Higher Ann Arbor staging 4
- Bulky disease 4
- Elevated inflammatory markers including neutrophil-to-lymphocyte ratio >3.5 and ferritin >173 ng/mL 4
Important Clinical Pitfalls
Do not confuse other constitutional symptoms with B symptoms. 1 The following are common presenting symptoms in pediatric lymphoma but are NOT B symptoms:
- Fatigue or lethargy (from bone marrow infiltration) 2, 3
- Easy bruising or bleeding (from thrombocytopenia) 2, 3
- Increased susceptibility to infections 3
- Bone pain 1
- Irritability 1
Chills may accompany fever but are not independently classified as a B symptom - only the fever itself counts. 1
Risk Stratification Impact
The presence of B symptoms affects treatment decisions in pediatric lymphoma: