Long-term effects of cancer treatment for non-Hodgkin lymphoma in children

Because of major advances in treatment, more children treated for lymphoma are living into adulthood. With childhood lymphoma survivors living longer, their health as they get older has come more into focus in recent years.

Just as the treatment of childhood lymphoma requires a very specialized approach, so does follow-up and monitoring for late effects of treatment. Careful follow-up after treatment is very important.

Childhood lymphoma survivors are at risk, to some degree, for several possible late effects of their cancer treatment. This risk depends on a number of factors, such as the type of lymphoma, the type of treatments they received, dosages of cancer treatment, and age at the time treatment.

Late effects of treatment can include:

• Heart or lung problems after getting certain chemotherapy drugs or getting radiation therapy to the chest
• Slowed or decreased growth and development (especially after a stem cell transplant)
• Bone damage or thinning of bones (osteoporosis)
• Changes in sexual development and ability to have children
• Changes in intellectual function with learning difficulties
• Development of second cancers, such as leukemia, later in life. These are not common, but they can occur.

There may be other possible complications from treatment as well. Your child’s doctor should carefully review any possible problems with you before your child starts treatment.

Along with physical side effects, survivors of childhood cancer may have emotional or psychological issues that need to be addressed. They also may have some problems with normal functioning and school work. These can often be addressed with support and encouragement. Doctors and other members of the health care team can also often recommend special support programs and services to help children after cancer treatment.

To help increase awareness of late effects and improve follow-up care of childhood cancer survivors throughout their lives, the Children’s Oncology Group (COG) has developed long-term follow-up guidelines for survivors of childhood cancers. These guidelines can help you know what to watch for, what type of screening should be done, and how late effects may be treated.

It is very important to discuss possible long-term complications with your child’s health care team, and to make sure there is a plan in place to watch for these problems and treat them, if needed. To learn more, ask your child's doctors about the COG survivor guidelines. You can also download them for free at the CureSearch Web site: www.survivorshipguidelines.org. The guidelines are written for health care professionals. Patient versions of some of the guidelines available (as “Health Links”) on the site as well, but we urge you to review them with a doctor.

For more about some of the possible long-term effects of treatment, see our document called Children Diagnosed With Cancer: Late Effects of Cancer Treatment.