This information represents the views of the doctors and nurses serving on the American Cancer Society's Cancer Information Database Editorial Board. These views are based on their interpretation of studies published in medical journals, as well as their own professional experience.

The treatment information in this document is not official policy of the Society and is not intended as medical advice to replace the expertise and judgment of your cancer care team. It is intended to help you and your family make informed decisions, together with your doctor.

Your doctor may have reasons for suggesting a treatment plan different from these general treatment options. Don't hesitate to ask him or her questions about your treatment options.

Before treatment starts, it's a good idea to talk to the cancer care team about the side effects your child might have. They can tell you about the common side effects, how long they might last, and how bad they might be.

Even if the disease seems to be confined to a single lymph node, it is likely to have spread. There may be cancer cells in other organs, but these are too small to be felt or seen on imaging tests. For this reason, all children with non-Hodgkin lymphoma (NHL) get chemotherapy (chemo), which can reach all parts of the body and kill lymphoma cells wherever they may be.

Surgery

Surgery is not often done to treat NHL, as it is not likely to cure the cancer by itself and normal organs might be damaged in the process. The major reasons for surgery include:

• To get biopsy samples for lab tests to find the exact type of NHL if other methods could not get enough tissue.

• To remove some lymphomas that are only in one part of the intestine.

• To relieve some emergency situations, such as if a lymphoma has blocked a child's intestines.

Radiation treatment

Radiation treatment is the use of high-energy rays to kill cancer cells. Radiation was once used very often for treating children with NHL. But as doctors have developed better chemo treatments, radiation treatment is used much less.

Radiation can be used to ease symptoms such as pain caused by the disease. Side effects of radiation treatment can include mild skin problems or tiredness. Treatment to the belly can cause upset stomach and diarrhea. Often these effects go away over time after treatment, and in most cases they can be treated.

But there can be long-term side effects. Radiation to the chest may cause lung damage and lead to breathing problems. There can also be a higher risk of getting lung cancer or breast cancer (for girls) in later years. If radiation treatment was given to the brain, side effects like headaches, memory loss, and trouble thinking could show up 1 or 2 years later. Treatment to the chest could affect the heart and blood vessels, which could lead to a heart attack. And there is the danger of other cancers (called sarcomas) developing later. Because of these possible long-term effects, doctors try to avoid using radiation treatment in children or limiting the doses used when they can.

Chemotherapy

Chemo is the use of drugs to kill cancer cells. Usually the drugs are given into a vein or by mouth. Once the drugs enter the bloodstream they spread throughout the body. This treatment is useful to treat cancer that has spread to other organs. For NHL, a combination of drugs is given over a period of time. All 3 types of this disease are treated with chemo. The number of drugs, their doses, and the length of treatment depend on the type and stage of the lymphoma.

Doctors give chemotherapy in cycles; a period of treatment is followed by a rest period to allow the body time to recover. Most often, a chemo cycle lasts for several weeks. Most chemo treatments are given in the doctor's office, clinic, or hospital outpatient department, but some may require a hospital stay.

Possible risks and side effects of chemo

Chemo can have some side effects. These side effects depend on the type of drugs given, the amount given, and how long treatment lasts. Side effects could include:

• hair loss (the hair grows back after treatment ends)
• mouth sores
• loss of appetite
• nausea and vomiting
• increased chance of infection (from low white blood cell counts)
• bleeding or bruising after minor cuts or injuries (from a shortage of platelets, cells that help the blood form a clot)
• extreme tiredness, called fatigue (from low red blood cell counts)

These side effects are usually short-term and go away after treatment ends. Your child's doctor or nurse can often suggest ways to reduce these side effects. Drugs can be given along with the chemo to prevent or reduce nausea and vomiting. Drugs known as growth factors can be given to keep the blood cell counts from getting too low.

Tumor lysis syndrome is a side effect of chemo that results from the rapid breakdown of lymphoma cells. When the cells are destroyed, they break open and release their contents into the bloodstream. This can affect the kidneys, heart, and nervous system. The problem can be prevented by making sure the child gets lots of fluids and giving certain drugs that help the body get rid of these waste substances.

Along with the side effects listed above, there are possible long-term effects of chemo in children, such as effects on fertility later in life. These are described in the section "Moving on after treatment."

Monoclonal antibodies

Antibodies are proteins normally made by the body's immune system to help fight infections. Man-made versions, called monoclonal antibodies, can be designed to attack a specific target, such as a substance on the surface of lymphoma cells.

Several monoclonal antibodies are now being used as treatments for lymphoma in adults. Some of these are now being studied for use in children as well.

Common side effects are usually mild but may include chills, fever, nausea, rashes, tiredness, and headaches. Even if these problems happen when the drug is first given, it is very unusual for them to continue.

Bone marrow transplantation and peripheral stem cell transplant (SCT)

These treatments are used for some children whose lymphoma comes back after treatment. They allow doctors to use higher doses of chemo than normal. But high doses of chemo drugs destroy the bone marrow, which prevents new blood cells from being formed. This could lead to deadly infection, bleeding, or other problems.

Doctors get around this by giving the child blood-forming stem cells after the chemo treatment. The stem cells are able to make new bone marrow cells. These stem cells can be taken either from the child and stored before treatment, or they can be donated from another person.

In the first approach (called an autologous transplant), the stem cells are removed from the child's bone marrow or bloodstream before treatment starts. They are frozen and stored. After treatment with high doses of chemo (and sometimes radiation), the cells are thawed and returned to the child through a vein. This is the most common approach.

The second method (called an allogeneic transplant) uses cells from another person. This may be done when cancer cells are found in the child's own bone marrow in order to avoid returning cancer cells to the child after treatment.

If the child has a brother or sister who has the same tissue type, their bone marrow cells (or perhaps blood-forming stem cells from the blood) can be used instead of the child's own cells. If a parent is a close match to the child, the parent's cells can be used. A matched, unrelated donor might also be used.

Stem cell transplants cost a lot (more than $100,000) and, in many cases, a long hospital stay is needed. Because it is so expensive, be sure to get a written approval from your insurer if transplant is recommended for your child. The best place to have a stem cell transplant done is at a nationally recognized cancer center where staff has experience with the procedure.

Side effects of SCT

Side effects from a stem cell transplant can be divided into early and long-term effects. Early side effects are about the same as those of any other type of high-dose chemo (low blood cell counts, nausea, vomiting, hair loss, etc.). They are caused by damage to the bone marrow and other tissues that reproduce quickly. One of the most common and serious short-term effects is the increased risk for infection. Antibiotics are often given to try to prevent this from happening. Other side effects, like low red blood cell and platelet counts, may mean that your child will need transfusions or other treatments.

Long-term side effects: Some side effects can go on for a long time. Sometimes they don't show up until months or even years after the transplant. Long-term side effects could include:

• graft-versus-host disease (When the immune system of the patient is taken over by that of the donor and the donor immune system begins reacting against the patient's other tissues and organs.)
• radiation damage to the lungs
• problems with the thyroid or other hormone-making glands
• fertility problems
• problems with bone growth

To learn more about this treatment, please see the ACS document Bone Marrow and Peripheral Blood Stem Cell Transplants.

Childhood non-Hodgkin lymphoma survival rates

Survival rates refer to the percentage of patients who live at least a certain amount of time after being diagnosed with cancer. For example, the 5-year survival rate refers to the percentage of children who live at least 5 years after their cancer is found. Of course, many children live much longer than 5 years.

The five-year survival rate for children with non-Hodgkin lymphoma ranges from around 70% to 90%, depending on the exact type of lymphoma.

These numbers provide an overall picture, but keep in mind that every person's situation is unique and the numbers can't predict exactly what will happen in your child's case. Talk with your cancer care team if you have questions about your child's chances of a cure. They know your child's situation best.

Last Medical Review: 07/29/2009
Last Revised: 07/29/2009