Treating Hodgkin Lymphoma in Children

Treatment of Hodgkin lymphoma in children is slightly different from the treatment for adults. Children’s bodies tend to tolerate chemotherapy better in the short term than adults do. But some side effects are more likely to occur in children. And because some of these side effects could be long-term, children who survive their cancer need careful attention for the rest of their lives.

Since the 1960s, most children and teens with cancer have been treated at special centers designed for them. Being treated in these centers offers the advantage of having a team of specialists who are experienced with the differences between adult and childhood cancers, as well as the unique needs of children with cancer and their families. This team usually includes pediatric oncologists, surgeons, radiation oncologists, pathologists, pediatric oncology nurses, and nurse practitioners.

Childhood cancer centers also have psychologists, social workers, child life specialists, nutritionists, rehabilitation and physical therapists, and educators who can support and educate the entire family.

Most children with cancer in the United States are treated at a center that is a member of the Children’s Oncology Group (COG). All of these centers are associated with a university or children’s hospital. As we have learned more about treating childhood cancer, it has become even more important that treatment be given by experts in this area.

In these centers, doctors treating children with Hodgkin lymphoma often use treatment plans that are part of clinical trials. The purpose of these studies is to find the most effective treatment that causes the fewest side effects.

Any time a child or teen is diagnosed with cancer, it affects every family member and nearly every aspect of the family’s life. You can read more about coping with these changes in Children Diagnosed With Cancer: Dealing With Diagnosis.

Differences from treatment in adults

As in adults, the main goal in treating Hodgkin lymphoma in children is to cure the lymphoma without causing long-term problems. Doctors adjust the treatment based on the child’s age, the extent of the lymphoma, how well the lymphoma is responding to treatment, and other factors.

If the child is past puberty and muscles and bones are fully developed, treatment is usually the same as that given to adults. But if the child has not reached his or her full body size, chemotherapy (chemo) will likely be favored over radiation therapy. This is because radiation can affect bone and muscle growth and prevent children from reaching their normal size.

When treating children with HL, doctors often combine chemo with low doses of radiation. The chemo often includes combinations of many drugs rather than just the usual adult ABVD regimen, especially for cancers that have unfavorable features or are more advanced. This approach has had excellent success rates, even for children with more advanced disease.

Stages IA and IIA, favorable: Treatment generally starts with chemo alone, used at the lowest dose that is likely to result in a cure. If the lymphoma doesn’t go away completely, radiation therapy or more chemo might be added.

If radiation therapy is used, the dose and area treated are kept as small as possible. If radiation is used on the lower part of the body in girls and young women, the ovaries should be protected to help preserve fertility.

Stages I and II, unfavorable: Treatment is likely to consist of more intense chemo combined with radiation therapy, although the dose and field of radiation are still kept as small as possible.

Stages III and IV: Treatment includes more intense chemo, either alone or combined with low-dose radiation therapy to areas with bulky disease (areas that contain a lot of lymphoma).

The treatment information given here is not official policy of the American Cancer 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. 

 

The American Cancer Society medical and editorial content team
Our team is made up of doctors and master’s-prepared nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Bartlett NL, Foyil KV. Chapter 105: Hodgkin lymphoma. In: Niederhuber JE, Armitage JO, Dorshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 5th ed. Philadelphia, Pa. Elsevier: 2014.

Children’s Oncology Group. Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent and Young Adult Cancers. 2014. Accessed at www.survivorshipguidelines.org on April 20, 2016.

National Cancer Institute. Physician Data Query (PDQ). Childhood Hodgkin Lymphoma Treatment. 2016. Accessed at www.cancer.gov/types/lymphoma/hp/child-hodgkin-treatment-pdq on April 20, 2016.

Younes A, Carbone A, Johnson P, Dabaja B, Ansell S, Kuruvilla J. Chapter 102: Hodgkin’s lymphoma. In: DeVita VT, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology. 10th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2015.

 

Last Medical Review: February 10, 2017 Last Revised: March 29, 2017

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