Drugs Other Than Chemo for Non-Hodgkin Lymphoma in Children

In recent years, new drugs that target specific parts of cancer cells have been developed. These drugs work differently from standard chemotherapy (chemo) drugs. They sometimes work when chemo drugs don’t, and they often have different side effects. Some of these drugs might be useful in certain cases of childhood non-Hodgkin lymphoma (NHL).

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 protein on the surface of lymphoma cells.

Several monoclonal antibodies are now being used to treat lymphoma in adults. Some of these are now being studied or used in children as well.

Rituximab (Rituxan): This antibody attaches to a protein called CD20 on the surface of some types of lymphoma cells, which seems to cause the cells to die. Rituximab is being studied for use along with chemotherapy. The treatments are typically given as intravenous (IV) infusions in the doctor’s office or clinic.

Common side effects are usually mild but can include chills, fever, nausea, rashes, fatigue, and headaches during or after the infusion. Even if these symptoms occur with the first rituximab infusion, it is unusual for them to happen with later doses. Rituximab can also increase a person’s risk of some types of infections.

Brentuximab vedotin (Adcetris): This is an anti-CD30 antibody attached to a chemotherapy drug. Some lymphoma cells have the CD30 protein on their surface. The antibody acts like a homing signal, bringing the chemo drug to the lymphoma cells, where it enters the cells and kills them when they try to divide into new cells.

Brentuximab can be used to treat anaplastic large cell lymphoma (ALCL) that has come back after other treatments. So far it has been used mainly in adults, but it's now being studied in children as well. It is given as an infusion into a vein (IV) every 3 weeks.

Common side effects include nerve damage (neuropathy), low blood counts, fatigue, fever, nausea and vomiting, infections, diarrhea, and cough.

ALK inhibitors

In most children with ALCL, the anaplastic lymphoma kinase (ALK) gene inside the ALCL cells is abnormal. Newer drugs called ALK inhibitors target cells with an abnormal ALK gene. These drugs have shown promising results in children with ALCL, usually after other treatments have been tried.

For example, crizotinib (Xalkori) can be used in children at least one year old who have ALCL that is no longer responding to other treatments. This drug is taken as pills, typically twice a day.

Common side effects of crizotinib (and other ALK inhibitors) can include nausea and vomiting, diarrhea or constipation, mouth sores, headaches, feeling tired, loss of appetite, changes in vision, and muscle and joint pain.

Less common but more serious side effects can include inflammation (swelling) in the lungs or other parts of the body, liver damage, serious vision problems, and heart rhythm problems.

Doctors are now studying the use of these drugs earlier in the course of treating ALCL, sometimes along with chemotherapy or other drugs.

Other drugs that target parts of lymphoma cells are now being studied for use in children as well.