Treating Hodgkin Lymphoma in Children

Treatment of Hodgkin lymphoma (HL) in children is slightly different from the treatment for adults. As for adults, the main goal in treating HL 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 keep children from reaching their normal size.

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. Because some of these side effects could be long-term, and because there could be late effects , children who survive 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 the entire family.

Most children with cancer in the United States are treated at a center that's 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 HL often use treatment plans that are part of clinical trials. The purpose of these studies is to find the best treatments that cause 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.

Treating classic Hodgkin lymphoma in children

When treating children with classic Hodgkin lymphoma (cHL), 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's likely to result in a cure. PET scans may be used to see if the treatment is working and/or if there's any lymphoma left in the body. If the HL doesn’t go away completely, radiation therapy or more chemo might be needed.

Studies have suggested that HL in children can be cured without using radiation. This avoids the long-term problems it can cause. But, 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, but 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).

Treating nodular lymphocyte-predominant Hodgkin lymphoma in children

Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is very rare in children. There's no single best treatment, and treatments used are often much like those used to treat cHL and/or those used to treat adult NLPHL . There is one exception: In the early stages of NLPHL in children, surgery to remove the affected lymph node may be the only treatment needed. After surgery, these children are watched closely for signs of lymphoma. Chemo can be used if it comes back.

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.

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Last Medical Review: May 1, 2018 Last Revised: May 1, 2018

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