Chemotherapy for Non-Hodgkin Lymphoma in Children

Chemotherapy, which destroys cancer cells, is the first-line treatment for childhood non-Hodgkin lymphoma. Pediatric oncologists at the Stephen D. Hassenfeld Children’s Center for Cancer and Blood Disorders, part of Hassenfeld Children’s Hospital at NYU Langone, determine the chemotherapy treatment for children and adolescents based on the type of non-Hodgkin lymphoma and how advanced it is. This includes analyzing the number, location, and size of tumors and whether the cancer has spread to the bone marrow, brain, or spine.

Childhood non-Hodgkin lymphoma tends to grow swiftly, so it’s important to start treatment as quickly as possible. Chemotherapy is considered the most effective method for destroying these fast-growing cells.

Chemotherapy for Burkitt Lymphoma and Diffuse Large B Cell Lymphoma

Our pediatric hematologist–oncologists typically treat children with Burkitt lymphoma or diffuse large B cell lymphoma with six to eight months of short, intensive “pulses” of chemotherapy. This means that a child is admitted to the hospital approximately every three weeks for five to seven days of intravenous (IV) infusions of chemotherapy drugs.

The infusions are delivered by way of a central venous catheter, usually a “mediport.” The port, a small device surgically implanted beneath the skin that attaches to a vein in the chest prior to treatment, minimizes damage to veins caused by chemotherapy drugs.

For children with more advanced non-Hodgkin lymphoma, doctors may combine chemotherapy with rituximab, a targeted therapy—meaning that the medication targets cancer cells and spares nearby healthy cells.

Chemotherapy for Anaplastic Large Cell Lymphoma

Chemotherapy for less advanced anaplastic lymphoma typically lasts three to six months. For more advanced cancers, 9 to 12 months of treatment may be necessary.

Our specialists usually treat these children with the same combination of chemotherapy medications used for children with Burkitt and diffuse large B-cell lymphomas. These lymphomas may be treated with newer targeted agents designed to block the growth and spread of cancer cells.

Treatments may include ALK inhibitors, which affect a translocation, or switching, of certain chromosomes. They may also include monoclonal antibodies, which are manmade molecules designed to attach to surface proteins on cancer cells to help the body fight cancer.

In anaplastic large cell lymphoma, monoclonal antibodies may be used to attach to CD30, a protein that appears on the surface of some lymphoma cells, which stops the cells from growing.

Chemotherapy for Lymphoblastic Lymphoma

At Hassenfeld Children’s Hospital, lymphoblastic lymphoma, a fast-growing type of childhood lymphoma, is frequently treated with a chemotherapy regimen similar to that given for childhood acute lymphoblastic leukemia, the most common cancer in children. This includes several phases of chemotherapy that can take two years to complete, beginning with a four-week “induction,” given by IV infusion, designed to destroy as many cancer cells as possible. The goal is to achieve remission, in which no cancer cells can be detected through laboratory tests.

Sometimes high levels of lymphoma cells linger after the early phases of treatment. If so, additional rounds of more intense chemotherapy may be administered. After a child achieves remission, doctors recommend maintenance chemotherapy, given both by mouth and through an IV infusion, to help prevent the cancer from returning.

Most children receive treatment for this type of lymphoma on an outpatient basis, usually for two years.

Managing Side Effects

Most chemotherapy medications are designed to attack cells that divide quickly, so they affect not only cancer cells but also healthy cells in the bone marrow, hair follicles, the immune system, the intestines, and the mouth. This can lead to side effects, which may include constipation, fatigue, flu-like symptoms, mouth sores, nausea, numbness in the hands and feet, hair loss, stomach pain, and vomiting.

Children receiving chemotherapy have an increased risk of infection, because the number of white blood cells circulating in the bloodstream is reduced for periods of time during treatment. Your child may receive an injection of a white blood cell–boosting medication after each round of chemotherapy.

Many side effects are temporary and often go away when therapy is completed.

Hair loss typically begins three to four weeks after the first round of chemotherapy for fast-growing types of non-Hodgkin lymphoma. Some children find hair loss to be traumatic. Our oncology nurses, social workers, and child psychologists help your child live with the emotional impact of hair loss and can recommend head coverings until the hair grows back, usually within weeks or months of completing chemotherapy.

Groups at the Stephen D. Hassenfeld Children’s Center for Cancer and Blood Disorders provide peer support for teens with non-Hodgkin lymphoma.

Sometimes treatments for childhood non-Hodgkin lymphoma can cause infertility in teens. Our specialists can provide information about options for banking sperm or freezing eggs before treatment. These procedures can take up to three weeks to complete, so your child’s doctor determines if it’s safe to delay chemotherapy.