Question: What are the treatments for Childhood Non-Hodgkin Lymphoma ?
Answer: Key Points - There are different types of treatment for children with non-Hodgkin lymphoma. - Children with non-Hodgkin lymphoma should have their treatment planned by a team of doctors who are experts in treating childhood cancer. - Some cancer treatments cause side effects months or years after treatment has ended. - Six types of standard treatment are used: - Chemotherapy - Radiation therapy - High-dose chemotherapy with stem cell transplant - Targeted therapy - Other drug therapy - Phototherapy - New types of treatment are being tested in clinical trials. - Patients may want to think about taking part in a clinical trial. - Patients can enter clinical trials before, during, or after starting their cancer treatment. - Follow-up tests may be needed. There are different types of treatment for children with non-Hodgkin lymphoma. Different types of treatment are available for children with non-Hodgkin lymphoma. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Taking part in a clinical trial should be considered for all children with non-Hodgkin lymphoma. Some clinical trials are open only to patients who have not started treatment. Children with non-Hodgkin lymphoma should have their treatment planned by a team of doctors who are experts in treating childhood cancer. Treatment will be overseen by a pediatric oncologist, a doctor who specializes in treating children with cancer. The pediatric oncologist works with other health care providers who are experts in treating children with non-Hodgkin lymphoma and who specialize in certain areas of medicine. These may include the following specialists: - Pediatrician. - Radiation oncologist. - Pediatric hematologist. - Pediatric surgeon. - Pediatric nurse specialist. - Rehabilitation specialist. - Psychologist. - Social worker. Some cancer treatments cause side effects months or years after treatment has ended. Side effects from cancer treatment that begin during or after treatment and continue for months or years are called late effects. Late effects of cancer treatment may include the following: - Physical problems. - Changes in mood, feelings, thinking, learning, or memory. - Second cancers (new types of cancer). Some late effects may be treated or controlled. It is important to talk with your child's doctors about the effects cancer treatment can have on your child. (See the PDQ summary on Late Effects of Treatment for Childhood Cancer for more information.) Six types of standard treatment are used: Chemotherapy Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid (intrathecal chemotherapy), an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas. Combination chemotherapy is treatment using two or more anticancer drugs. The way the chemotherapy is given depends on the type and stage of the cancer being treated. Intrathecal chemotherapy may be used to treat childhood non-Hodgkin lymphoma that has spread, or may spread, to the brain. When used to lessen the chance cancer will spread to the brain, it is called CNS prophylaxis. Intrathecal chemotherapy is given in addition to chemotherapy by mouth or vein. Higher than usual doses of chemotherapy may also be used as CNS prophylaxis. See Drugs Approved for Non-Hodgkin Lymphoma for more information. Radiation therapy Radiation therapy is a cancer treatment that uses high energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy: - External radiation therapy uses a machine outside the body to send radiation toward the cancer. - Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type of non-Hodgkin lymphoma being treated. External radiation therapy may be used to treat childhood non-Hodgkin lymphoma that has spread, or may spread, to the brain and spinal cord. Internal radiation therapy is not used to treat non-Hodgkin lymphoma. High-dose chemotherapy with stem cell transplant This treatment is a way of giving high doses of chemotherapy and then replacing blood -forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the bone marrow or blood of the patient or a donor and are frozen and stored. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the bodys blood cells. See Drugs Approved for Non-Hodgkin Lymphoma for more information. Targeted therapy Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells. Monoclonal antibodies, tyrosine kinase inhibitors, and immunotoxins are three types of targeted therapy being used or studied in the treatment of childhood non-Hodgkin lymphoma. Monoclonal antibody therapy is a cancer treatment that uses antibodies made in the laboratory from a single type of immune system cell. These antibodies can identify substances on cancer cells or normal substances that may help cancer cells grow. The antibodies attach to the substances and kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion. They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells. - Rituximab is used to treat several types of childhood non-Hodgkin lymphoma. - Brentuximab vedotin is a monoclonal antibody combined with an anticancer drug that is used to treat anaplastic large cell lymphoma. A bispecific monoclonal antibody is made up of two different monoclonal antibodies that bind to two different substances and kills cancer cells. Bispecific monoclonal antibody therapy is used in the treatment of Burkitt and Burkitt-like lymphoma /leukemia and diffuse large B-cell lymphoma. Tyrosine kinase inhibitors (TKIs) block signals that tumors need to grow. Some TKIs also keep tumors from growing by preventing the growth of new blood vessels to the tumors. Other types of kinase inhibitors, such as crizotinib, are being studied for childhood non-Hodgkin lymphoma. Immunotoxins can bind to cancer cells and kill them. Denileukin diftitox is an immunotoxin used to treat cutaneous T-cell lymphoma. See Drugs Approved for Non-Hodgkin Lymphoma for more information. Other drug therapy Retinoids are drugs related to vitamin A. Retinoid therapy with bexarotene is used to treat several types of cutaneous T-cell lymphoma. Steroids are hormones made naturally in the body. They can also be made in a laboratory and used as drugs. Steroid therapy is used to treat cutaneous T-cell lymphoma. Phototherapy Phototherapy is a cancer treatment that uses a drug and a certain type of laser light to kill cancer cells. A drug that is not active until it is exposed to light is injected into a vein. The drug collects more in cancer cells than in normal cells. For skin cancer in the skin, laser light is shined onto the skin and the drug becomes active and kills the cancer cells. Phototherapy is used in the treatment of cutaneous T-cell lymphoma. New types of treatment are being tested in clinical trials. Information about clinical trials is available from the NCI website. Patients may want to think about taking part in a clinical trial. For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment. Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment. Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward. Patients can enter clinical trials before, during, or after starting their cancer treatment. Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment. Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials. Follow-up tests may be needed. Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your child's condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups. Treatment Options for Childhood Non-Hodgkin Lymphoma Burkitt and Burkitt-like lymphoma/leukemia Treatment options for newly diagnosed Burkitt and Burkitt-like lymphoma/leukemia Treatment options for newly diagnosed Burkitt and Burkitt-like lymphoma /leukemia may include: - Surgery to remove as much of the tumor as possible, followed by combination chemotherapy. - Combination chemotherapy. - Combination chemotherapy and targeted therapy (rituximab). Treatment options for recurrent Burkitt and Burkitt-like lymphoma/leukemia Treatment options for recurrent Burkitt and Burkitt-like non-Hodgkin lymphoma /leukemia may include: - Combination chemotherapy and targeted therapy (rituximab). - High-dose chemotherapy with stem cell transplant with the patient's own cells or cells from a donor. - Targeted therapy with a bispecific antibody. Check the list of NCI-supported cancer clinical trials that are now accepting patients with childhood Burkitt lymphoma, stage I childhood small noncleaved cell lymphoma, stage II childhood small noncleaved cell lymphoma, stage III childhood small noncleaved cell lymphoma, stage IV childhood small noncleaved cell lymphoma and recurrent childhood small noncleaved cell lymphoma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your child's doctor about clinical trials that may be right for your child. General information about clinical trials is available from the NCI website. Diffuse large B-cell lymphoma Treatment options for newly diagnosed diffuse large B-cell lymphoma Treatment options for newly diagnosed diffuse large B-cell lymphoma may include: - Surgery to remove as much of the tumor as possible, followed by combination chemotherapy. - Combination chemotherapy. - Combination chemotherapy and targeted therapy (rituximab). Treatment options for recurrent diffuse large B-cell lymphoma Treatment options for recurrent diffuse large B-cell lymphoma may include: - Combination chemotherapy and targeted therapy (rituximab). - High-dose chemotherapy with stem cell transplant with the patient's own cells or cells from a donor. - Targeted therapy with a bispecific antibody. Check the list of NCI-supported cancer clinical trials that are now accepting patients with childhood diffuse large cell lymphoma, stage I childhood large cell lymphoma, stage II childhood large cell lymphoma, stage III childhood large cell lymphoma, stage IV childhood large cell lymphoma and recurrent childhood large cell lymphoma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your child's doctor about clinical trials that may be right for your child. General information about clinical trials is available from the NCI website. Primary Mediastinal B-cell Lymphoma Treatment options for primary mediastinal B-cell lymphoma Treatment options for primary mediastinal B-cell lymphoma may include: - Combination chemotherapy and targeted therapy (rituximab). Lymphoblastic Lymphoma Treatment options for newly diagnosed lymphoblastic lymphoma Lymphoblastic lymphoma may be classified as the same disease as acute lymphoblastic leukemia (ALL). Treatment options for lymphoblastic lymphoma may include: - Combination chemotherapy. CNS prophylaxis with radiation therapy or chemotherapy is also given if cancer has spread to the brain and spinal cord. - A clinical trial of chemotherapy with different regimens for CNS prophylaxis. - A clinical trial of combination chemotherapy with or without targeted therapy (bortezomib). Treatment options for recurrent lymphoblastic lymphoma Treatment options for recurrent lymphoblastic lymphoma may include: - Combination chemotherapy. - High-dose chemotherapy with stem cell transplant with cells from a donor. Check the list of NCI-supported cancer clinical trials that are now accepting patients with stage I childhood lymphoblastic lymphoma, stage II childhood lymphoblastic lymphoma, stage III childhood lymphoblastic lymphoma, stage IV childhood lymphoblastic lymphoma and recurrent childhood lymphoblastic lymphoma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your child's doctor about clinical trials that may be right for your child. General information about clinical trials is available from the NCI website. Anaplastic Large Cell Lymphoma Treatment options for newly diagnosed anaplastic large cell lymphoma Treatment options for anaplastic large cell lymphoma may include: - Surgery followed by combination chemotherapy. - Combination chemotherapy. - Intrathecal and systemic chemotherapy, for patients with cancer in the brain or spinal cord. - A clinical trial of targeted therapy (crizotinib or brentuximab) and combination chemotherapy. Treatment options for recurrent anaplastic large cell lymphoma Treatment options for recurrent anaplastic large cell lymphoma may include: - Chemotherapy with one or more drugs. - Stem cell transplant with the patient's own cells or cells from a donor. - A clinical trial of targeted therapy (crizotinib) in children with recurrent anaplastic large cell lymphoma and changes in the ALK gene. - A clinical trial of targeted therapy (crizotinib) and combination chemotherapy. Check the list of NCI-supported cancer clinical trials that are now accepting patients with stage I childhood anaplastic large cell lymphoma, stage II childhood anaplastic large cell lymphoma, stage III childhood anaplastic large cell lymphoma, stage IV childhood anaplastic large cell lymphoma and recurrent childhood anaplastic large cell lymphoma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your child's doctor about clinical trials that may be right for your child. General information about clinical trials is available from the NCI website. Lymphoproliferative Disease Associated With Immunodeficiency in Children Treatment options for lymphoproliferative disease associated with primary immunodeficiency Treatment options for lymphoproliferative disease in children and adolescents with weakened immune systems may include: - Chemotherapy. - Stem cell transplant with cells from a donor. Treatment options for HIV-associated non-Hodgkin lymphoma Treatment with highly active antiretroviral therapy or HAART (a combination of antiretroviral drugs) lowers the risk of non-Hodgkin lymphoma in patients infected with the human immunodeficiency virus (HIV). Treatment options for HIV-related non-Hodgkin lymphoma (NHL) in children may include: - Chemotherapy. For treatment of recurrent disease, treatment options depend on the type of non-Hodgkin lymphoma. Treatment options for post-transplant lymphoproliferative disease Treatment options for post-transplant lymphoproliferative disease may include: - Surgery to remove the tumor. If possible, lower doses of immunosuppressive drugs after a stem cell or organ transplant may be given. - Targeted therapy (rituximab). - Chemotherapy with or without targeted therapy (rituximab). - A clinical trial of immunotherapy using donor lymphocytes or the patient's own T cells to target Epstein-Barr infection. Rare NHL Occurring in Children Treatment options for pediatric-type follicular lymphoma Treatment options for follicular lymphoma in children may include: - Surgery. - Combination chemotherapy. For children whose cancer has certain changes in the genes, treatment is similar to that given to adults with follicular lymphoma. See the Follicular Lymphoma section in the PDQ summary on Adult Non-Hodgkin Lymphoma for information. Treatment options for marginal zone lymphoma Treatment options for marginal zone lymphoma in children may include: - Surgery. - Radiation therapy. - Antibiotic therapy, for mucosa-associated lymphoid tissue (MALT) lymphoma. Treatment options for primary CNS lymphoma Treatment options for primary CNS lymphoma in children may include: - Chemotherapy. Treatment options for peripheral T-cell lymphoma Treatment options for peripheral T-cell lymphoma in children may include: - Chemotherapy. - Radiation therapy. - Stem cell transplant with the patient's own cells or cells from a donor. Treatment options for cutaneous T-cell lymphoma Treatment options for subcutaneous panniculitis-like cutaneous T-cell lymphoma in children may include: - Watchful waiting. - High-dose steroids. - Targeted therapy (denileukin diftitox). - Combination chemotherapy. - Retinoid therapy. - Stem cell transplant. Treatment options for cutaneous anaplastic large cell lymphoma may include: - Surgery, radiation therapy, or both. In children, treatment options for mycosis fungoides may include: - Steroids applied to the skin. - Retinoid therapy. - Radiation therapy. - Phototherapy (light therapy using ultraviolet B radiation).