Treating Lymphoma in Children

Lymphoma is one of the most common cancers in children. Lymphoma that occurs in children is often different than cancers in adults. While cancers like lymphoma tend to be more aggressive in children than adults, these types of cancer generally respond well to treatment. Children are also typically able to better handle stronger, more intense courses of chemotherapy compared to adults. More children are surviving cancers like lymphoma now than ever before.1,2

There are 2 major types of lymphoma:3

  • Hodgkin lymphoma (also called Hodgkin disease) – This accounts for about 3 percent of all childhood cancers. It is more common among young adults (usually in their 20s) and older adults (after age 55).
  • Non-Hodgkin lymphoma (NHL) – This accounts for about 5 percent of all childhood cancers.

Types of treatment for childhood lymphoma

Several different types of therapies may be used to treat lymphoma in children, including:4,5

  • Chemotherapy
  • Stem cell transplant
  • Targeted therapy
  • Radiation therapy
  • Immunotherapy
  • Surgery
  • Phototherapy

Chemotherapy

Chemotherapy is the use of drugs to stop cancer cells. Chemotherapy drugs may be used with other drugs. Chemotherapy works by targeting fast-growing cells, such as cancer cells. However, there are other fast-growing cells in the body that can also be affected, such as those in the gastrointestinal tract and hair.4,5

The way chemotherapy drugs are delivered depends on the type of lymphoma and how it is affecting the body. Some drugs are given by mouth, while others are injected into a vein or muscle. When lymphoma is affecting the brain or spinal cord, chemotherapy may be injected into the space around the spinal cord and brain. This is called intrathecal chemotherapy (as shown below). Chemotherapy may also be injected into an organ or into the abdomen.4,5

Figure 1. Intrathecal chemotherapy

Human body showing central nervous system with needle injecting chemotherapy into space around the spinal column and brain

Stem cell transplants

Stem cell transplants are used along with high doses of chemotherapy. The high doses destroy cancer cells, but they also damage healthy blood cells. The transplant of stem cells (immature cells that can become new blood cells) is given to restore the bone marrow.4,5

The stem cells may be gathered from the person before chemotherapy. This is called an autologous transplant. Or, they may be given by a donor. This is called an allogeneic transplant. Autologous stem cell transplants are generally more common in childhood lymphoma treatment. If an allogeneic stem cell transplant is performed, the donor’s tissue type should match the tissue type of the child to the closest extent possible. Siblings or close relatives are often donors. However, the donor does not have to be related to the person receiving the transplant.4,5

Targeted therapy

Targeted therapies are cancer treatments that block or slow the spread of cancer. They work by interfering with specific areas of cancer cells that are involved in the cancer cell’s growth or by focusing on features that are unique to cancer cells. Chemotherapy drugs are often cytotoxic, meaning they kill cancer cells. However, targeted therapy is typically cytostatic, meaning it blocks the growth of cancer cells. Types of targeted therapy used to treat childhood lymphomas include:4,5

  • Tyrosine kinase inhibitors (TKIs), which target a specific protein found on certain cancer cells.
  • Monoclonal antibodies, which identify and block cancer growth or kill cancer cells. They may also be used to deliver chemotherapy drugs to cancer cells.
  • Proteasome inhibitors block the action of proteasomes, which remove proteins inside cancer cells. By blocking the normal action of proteasomes, these treatments can increase proteins in cancer cells and cause them to die.
  • Immunotoxins, which bind to cancer cells and cause them to die.

Radiation therapy

Radiation therapy uses high-energy radiation. It may be used in certain cases of childhood lymphoma. Radiation may also be used in preparation for a stem cell transplant.4,5

Immunotherapy

Immunotherapy, also called biologic therapy, helps boost the body's immune system to fight cancer. Immunotherapies approved to treat some forms of lymphoma in children include certain immune checkpoint inhibitors.5

Surgery

Surgery may be used to remove tumors in certain cases of lymphoma.5

Phototherapy

Phototherapy uses a drug and a type of laser light to kill cancer cells. The drug is injected into a vein and becomes active when the laser light is shined on the skin. Phototherapy may be used to treat some people with a type of NHL called cutaneous T-cell lymphoma.4

Clinical trials

Clinical trials are a type of research where new treatments are studied. Clinical trials are an important part of the scientific process to find and prove the safety and effectiveness of new treatments. They offer people a chance to receive the latest treatments and be closely monitored by doctors. You can learn more about clinical trials by talking to your doctor or visiting the ClinicalTrials.gov website. Your doctor can help you decide if a clinical trial may be right for you.2,6

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Written by: Emily Downward | Last reviewed: April 2021