What`s new in research and treatment of non-Hodgkin lymphoma in children?

Research on the causes, diagnosis, and treatment of childhood non-Hodgkin lymphoma is being done at many medical centers, university hospitals, and other institutions across the nation.

Genetics

As noted in the section, “Do we know what causes non-Hodgkin lymphoma in children?” scientists are making great progress in understanding how changes in DNA can cause normal lymphocytes to develop into lymphoma cells.

Understanding the gene changes that often occur in non-Hodgkin lymphoma is providing insight into why these cells may grow too quickly, live too long, and do not develop into normal, mature cells. This information is being used to develop new treatments for lymphoma.

This progress has also led to vastly improved and highly sensitive tests for detecting and monitoring this disease. Tests such as the polymerase chain reaction (PCR) can identify non-Hodgkin lymphoma cells based on some of these gene changes. This test is useful in determining how completely the lymphoma has been destroyed by treatment and whether a relapse is likely if further treatment is not given.

Clinical trials of new treatments

Most children with non-Hodgkin lymphoma are treated at major medical centers, where treatment often involves taking part in clinical trials to provide the most up-to-date care. Several important questions are now being studied in clinical trials, such as:

• Can all early stage (stages I and II) non-Hodgkin lymphomas be treated similarly?
• What is the best length of treatment of each type of non-Hodgkin lymphoma?
• Can less intense treatment provide as good an outcome as the highly intense treatments and thus help children possibly avoid some long-term side effects?
• Can new chemotherapy drugs and new combinations of drugs improve cure rates?
• Can newer, targeted drugs such as monoclonal antibodies be added to current treatments to make them better? (See “Monoclonal antibodies for non-Hodgkin lymphoma in children.”)

An example of a promising new drug is crizotinib (Xalkori). This drug targets the anaplastic lymphoma kinase (ALK) gene, which is often abnormal in anaplastic large cell lymphoma (ALCL). In early studies, this drug has shown very promising results in children with ALCL that is no longer responding to other treatments. Doctors are now trying to determine how to best fit this drug into the treatment of ALCL.