Targeted Therapy for 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, and they often have different side effects.

Targeted therapy can be useful for some lymphomas that affect children and adolescents.

Antibody-drug conjugates (ADCs)

Antibody-drug conjugates are a type of targeted therapy that links a human-made immune protein, known as a monoclonal antibody, to a chemotherapy drug.

The antibody acts like a homing device. It brings the chemo drug to the lymphoma cells, where it enters the cells and kills them when they try to divide into new cells.

Brentuximab vedotin (Adcetris) is an example of this type of targeted therapy. It is given as an infusion into a vein (IV), typically every 2 or 3 weeks.

Types of lymphoma treated

This drug might be used to treat:

• Hodgkin lymphoma
• Anaplastic large cell lymphoma (ALCL)
• Large B cell lymphomas that are not responding to treatment or come back after treatment
• Peripheral T-cell lymphomas

Possible side effects

Common side effects include:

• Nerve damage (neuropathy)
• Low blood counts
• Fatigue
• Fever
• Nausea and vomiting
• Infections
• Diarrhea
• Cough

ALK inhibitors

Some lymphomas have changes in the ALK gene. These changes help the cancer grow. Drugs that target changes in the ALK gene can be helpful for children and adolescents with these tumors.

These drugs include:

• Crizotinib (Xalkori)
• Alectinib (Alecensa)
• Ceritinib (Zykadia)

They are given by mouth once or twice a day.

Types of lymphoma treated

Lymphomas that grow from T cells, such as anaplastic large cell lymphoma (ALCL), often have changes in the ALK gene that can be targeted by this type of treatment. 

Possible side effects

Common side effects of ALK inhibitors can include:

• Nausea and vomiting
• Diarrhea or constipation
• Mouth sores
• Headache
• Fatigue
• Loss of appetite
• Changes in vision
• 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.

Proteasome inhibitors

Proteasome inhibitors are a type of targeted therapy that causes protein waste to build up in cancer cells.

Enzyme complexes inside cancer cells, known as proteasomes, have the job of breaking down proteins when they are no longer needed. Proteasome inhibitors stop this breakdown from happening, causing protein waste to build up inside the cancer cells. The cancer cells can no longer grow and divide, so they die.

Bortezomib (Velcade) is an example of this type of targeted therapy. It is injected under the skin or given through a vein (IV).

Types of lymphoma treated

Proteasome inhibitors can be used in the treatment of T-cell lymphoblastic lymphoma.

Possible side effects

Common side effects of proteasome inhibitors are:

• Nerve damage (neuropathy)
• Low blood counts
• Nausea
• Loss of appetite