Chemotherapy for Non-Hodgkin Lymphoma in Children

Chemotherapy (chemo) is the main treatment for non-Hodgkin lymphoma (NHL) in children. Chemo uses anti-cancer drugs that are usually given into a vein (IV) 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 NHL in children. If the lymphoma may have reached the brain or spinal cord, chemo may also be given into the cerebrospinal fluid (known as intrathecal chemo).

Which chemo drugs are used to treat non-Hodgkin lymphoma in children?

Children with NHL get a combination of several chemo drugs 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 chemo drugs commonly used to treat childhood lymphoma include:

  • Cyclophosphamide (Cytoxan)
  • Vincristine (Oncovin)
  • Doxorubicin (Adriamycin)
  • Prednisone
  • Dexamethasone
  • 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 in an outpatient setting (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

Chemo drugs can cause side effects. These depend on the type and dose of drugs given and how long treatment lasts. Common 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 usually go away after treatment is finished. If serious side effects occur, the dose of chemo may be reduced or treatment may be delayed.

There are often ways to lessen these side effects. For example:

  • Drugs 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.
  • Tumor lysis syndrome is a possible side effect of chemo in children who have large numbers of lymphoma cells in the body before treatment. It occurs most often with the first cycle of chemo. Killing the lymphoma cells releases their contents into the bloodstream. This can overwhelm the kidneys, which can’t get rid of all of these substances at once. Excess amounts of certain minerals may also lead to heart and nervous system problems. This 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 about them.

Along with the side effects listed above, there are possible long-term effects of chemo in children, such as possible effects on fertility later in life. These are described in Late and Long-term Effects of Treatment for Non-Hodgkin Lymphoma in Children.

More information about chemotherapy

For more general information about how chemotherapy is used to treat cancer, see Chemotherapy.

To learn about some of the side effects listed here and how to manage them, see Managing Cancer-related Side Effects.

The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

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Last Revised: August 4, 2017

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