Chemotherapy for non-Hodgkin lymphoma in children

Chemotherapy (chemo) uses anti-cancer drugs that are usually given into a vein or taken by mouth. These drugs enter the bloodstream and reach all areas of the body, making this treatment very useful for cancers that tend to spread widely, such as lymphomas. In some cases where the lymphoma may have reached the brain or spinal cord, chemotherapy may also be given into the cerebrospinal fluid.

The treatment for children with non-Hodgkin lymphoma is a combination of several chemo drugs given over a period of time. The number of drugs, their doses, and the length of treatment depend on the type and stage of the lymphoma. Some of the drugs commonly used to treat childhood lymphoma include:

• Cyclophosphamide (Cytoxan)
• Vincristine (Oncovin)
• Doxorubicin (Adriamycin)
• Prednisone
• Cytarabine, also known as ara-C (Cytosar)
• Methotrexate
• L-asparaginase (Elspar), PEG-L-asparaginase (pegaspargase, Oncaspar)
• Etoposide (VePesid, others)
• 6-mercaptopurine (Purinethol)
• Ifosfamide (Ifex)

Doctors give chemo in cycles, in which a period of treatment is followed by a rest period to allow the body time to recover. Each chemo cycle generally lasts for several weeks. Most chemo treatments are given on an outpatient basis (in the doctor’s office or clinic or hospital outpatient department), but some – especially at the start of treatment – may need to be given while the child stays in the hospital.

Possible risks and side effects of chemotherapy

Chemo drugs attack cells that are dividing quickly, which is why they work against cancer cells. But other cells in the body, such as those in the bone marrow, the lining of the mouth and intestines, and the hair follicles, also divide quickly. These cells are also likely to be affected by chemotherapy, which can lead to side effects.

The side effects of chemo depend on the type and dose of drugs given and how long they are taken. These side effects can include:

• Hair loss
• Mouth sores
• Loss of appetite
• Nausea and vomiting
• Diarrhea
• Increased chance of infections (due to low white blood cell counts)
• Easy bruising or bleeding (due to low blood platelet counts)
• Fatigue (due to low red blood cell counts)

These side effects are usually short-term and go away after treatment is finished. If serious side effects occur, chemotherapy may have to be reduced or delayed. There are often ways to lessen these side effects. For example, there are drugs that can be given to help prevent or reduce nausea and vomiting.

Infections can be very serious in people getting chemo. Drugs known as growth factors can be given to keep the blood cell counts higher. Be sure to ask your child’s doctor or nurse about medicines to help reduce side effects, and let him or her know when your child does have side effects so they can be managed effectively.

Tumor lysis syndrome is a possible side effect of chemotherapy in children who had large numbers of lymphoma cells in the body before treatment. It occurs most often with the first cycle of chemo. When chemo kills these cells, they break open and release their contents into the bloodstream. This can overwhelm the kidneys, which aren’t able to get rid of all of these substances at once. Excess amounts of certain minerals may also affect the heart and nervous system. This problem can be prevented by making sure the child gets lots of fluids during treatment and by giving drugs such as bicarbonate, allopurinol, and rasburicase, which help the body get rid of these substances.

Some possible side effects occur only with certain drugs. For example, drugs such as doxorubicin can damage the heart. Your child’s doctor may order heart function tests (like a MUGA scan or echocardiogram) if your child is getting one of these drugs. Be sure to ask your child’s doctor or nurse about any specific side effects you should watch for and about what you can do to help reduce these side effects.

Along with the side effects listed above, there are possible long-term effects of chemotherapy in children, such as possible effects on fertility later in life. These are described in the section, “What happens after treatment for non-Hodgkin lymphoma in children.”