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 serious they might be.

Even if the disease appears to be confined to a single lymph node, it is likely to have spread already. There may be cancer cells in other organs, but these are too small to be felt or seen on imaging tests. This is why surgery and radiation are not commonly used to treat this disease, except to get a better biopsy sample or to relieve a blockage in the child’s intestine.

Radiation can also 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 abdomen can cause upset stomach and diarrhea. Often these effects go away after a short while.

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 the brain received radiation treatment, side effects such as headaches and trouble thinking could show up 1 or 2 years later. Treatment to the chest could affect the heart and blood vessels. And there is the danger of other cancers (sarcomas) developing later.

Chemotherapy

Chemotherapy 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 for cancer that has spread to other organs. For non-Hodgkin lymphoma, a combination of several drugs is given over a period of time. All 3 types of this disease are treated with chemotherapy. The difference is in which drugs are used and for how long they are given.

Chemotherapy 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 the following:

• hair loss (the hair grows back after treatment ends)
• diarrhea
• nausea
• mouth sores
• 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)
• fatigue (from low red blood cell counts)

Your child's doctor can often suggest ways to reduce these side effects. Drugs can be given along with chemotherapy to prevent or reduce nausea and vomiting. Drugs known as growth factors can be given to help keep the blood cell counts higher.

Tumor lysis syndrome is a side effect of chemotherapy that results from the rapid breakdown of lymphoma cells. When the cells are destroyed, they 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 substances.

Organs that can be directly damaged by some chemotherapy include the kidneys, liver, testes, ovaries, brain, heart, and lungs. With careful watching, life-threatening side effects are rare. Sometimes the chemotherapy may have to be reduced or stopped for a while.

One of the most serious side effects of treatment is the possibility of your child getting a second cancer called AML (acute myeloid leukemia). This is quite rare, and the importance of chemotherapy in treating non-Hodgkin lymphoma in children far outweighs the small risk.

Monoclonal antibodies are another form of treatment. They are like antibodies that are made by the immune system, but they are made in the lab. Instead of attacking germs the way natural antibodies do, some monoclonal antibodies are designed to attack lymphoma cells.

After years of research, several monoclonal antibodies are now being used as treatments for lymphoma. In fact, more monoclonal antibodies are available to treat lymphoma than any other type of cancer.

The first monoclonal antibody approved by the FDA to treat any cancer was rituximab (Rituxan). Common side effects are usually mild but may include chills, fever, nausea, rashes, fatigue, and headaches. Even if these problems happen when rituximab is first given, it is very unusual for them to continue. Other monoclonal antibodies to treat lymphomas are also being developed.

These treatments are used for children who relapse during or after treatment. They allow doctors to use higher doses of chemotherapy than would normally be the case. But high doses of chemotherapy drugs destroy the bone marrow, which prevents new blood cells from being formed. This could be life-threatening.

Doctors try to avoid this problem by giving the child blood-forming stem cells after treatment. The stem cells are able to create 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 chemotherapy (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 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.

These transplant treatments are complex. If the doctor thinks your child might benefit from transplantation, the best place to have it may be in a nationally recognized cancer center or in a hospital associated with a university. The staff there should have experience with the procedure. 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

The five-year survival rate for children younger than 20 years old with non-Hodgkin lymphoma ranges from around 70% to 90%, depending on the exact type of lymphoma. This rate refers to patients who live at least 5 years after the cancer is found. Of course, many patients live much longer than 5 years.

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.