Cancers and Tumors

Hodgkin Lymphoma

What is Hodgkin lymphoma?

Lymphoma is cancer of the lymph system. It can start anywhere in the lymph system and can spread to other parts of the body.

There are 2 main types of lymphoma:

Hodgkin lymphoma and non-Hodgkin lymphoma are different in how they:

  • Spread
  • Affect the body
  • Respond to treatment

To have the best chance of a cure, your child needs care by a team experienced in treating this cancer in children. Your child will have that team at our Leukemia and Lymphoma Program.

  • The lymph system is a network of small vessels that collect a watery fluid (lymph) from all around the body. It is part of your child’s immune system.

    White blood cells called lymphocytes travel in the lymph, fighting infection and disease. Along the network of lymph vessels are bean-like structures called lymph nodes. They filter the lymph and serve as centers where the body fights disease.

  • Doctors do not know what causes Hodgkin lymphoma. There is no known way to prevent it.

    Most children who have Hodgkin lymphoma have no clear risk factors. But the chance of this cancer is higher in children who:

    • Came into contact with the Epstein-Barr virus (pronounced ep-stine-BAR VY-rus)
    • Had mononucleosis (pronounced mah-no-noo-klee-OH-sis)

Hodgkin Lymphoma at Seattle Children’s

At Seattle Children’s, we care for many families each year who have a child with Hodgkin lymphoma. Many of the children we treat return to their normal lives after treatment and never have cancer again.

The experts in our Leukemia and Lymphoma Program provide advanced therapies for children with all types of Hodgkin lymphoma, including lymphoma that comes back (recurs). We treat more young people with lymphoma and leukemia than any other center in the region. See our statistics and outcomes.

The program is part of the Cancer and Blood Disorders Center at Seattle Children’s. Please contact the center at 206-987-2106 for more information, a second opinion or to make an appointment.

  • A doctor specially trained in diagnosing and treating cancer in children (pediatric oncologist) will guide your child’s care. Your child’s team will also include a nurse practitioner and a social worker.

    We care for your whole child. We don’t just treat their cancer. As needed, your child will receive care from specialists in nutrition, pain management, pharmacy, physical therapy, psychology and emotional health. Read more about the supportive care we offer.

    Treatment options for Hodgkin’s lymphoma include new combinations of medicine (chemotherapy and targeted therapy), stem cell transplants and radiation therapy.

    We provide stem cell transplants through Fred Hutch, whose doctors pioneered this lifesaving treatment. If your child needs a stem cell transplant, their cancer doctor will work closely with the transplant team to plan their treatment. The plan includes:

    • How to get your child’s disease in remission
    • The best kind of transplant for your child
    • How to reduce the risk of cancer coming back after transplant
    • How to reduce the risks for long term complications from the cancer therapy

  • In 2016, U.S. News & World Report ranked Seattle Children’s Cancer Center number 1 in the West and number 6 in the country.

    Our outcomes for Hodgkin lymphoma are significantly better than the national average.

    Through our partnership in the Seattle Cancer Care Alliance (SCCA), your child will benefit from the work of physician-scientists at Fred Hutch and UW Medicine, as well as at Seattle Children’s. The National Cancer Institute has designated our partnership a comprehensive cancer center.

    Our experience helps us recommend the right treatment at the right time to have the best results for your child and your family.

  • At Seattle Children’s, your child’s treatment for Hodgkin lymphoma depends on their disease and how it responds to the first type of therapy given. This is known as risk-adapted, response-driven therapy. It is designed both to cure the disease and to limit any long-term effects from the treatment.

    Our doctors are leaders in lymphoma research, including care of survivors of Hodgkin lymphoma. Dr. Eric Chow chairs the Outcomes and Survivorship Committee of the Children’s Oncology Group (COG). COG is an international organization of childhood cancer specialists who work to develop new treatments and reduce later effects of the disease and treatments.

    We work hard to find the best possible research study for your child. Our research leadership means we can offer our patients the very latest options being studied, including Phase 1 clinical trials. These early studies are especially important if your child’s cancer does not respond well to treatment or comes back.

    Read more about cancer clinical trials at Seattle Children’s.

    You can search by diagnosis for many clinical trials available through Seattle Children’s on ClinicalTrials.gov. Read our guide about searching for trials on ClinicalTrials.gov (PDF). You can search for bone marrow transplant clinical trials on Fred Hutch’s clinical trials page.

  • Our specialty is treating children’s cancer while helping them grow up to be healthy and productive adults.

    Children don’t react to illness, injury, pain and medicine in the same way as adults. They need – and deserve – care designed just for them.

    Our cancer doctors have special training in how to diagnose and treat children with cancer. They base their treatment plans on years of experience and the newest research on what works best – and most safely – for children.

    Our experts focus on how treatments today affect growing bodies in the future. Dr. Eric Chow leads a study to learn more about the long-term physical and psychological effects of cancer treatments in people who had the disease as children or teens.

  • A diagnosis of Hodgkin lymphoma can be scary. We help take positive steps right away by offering appointments within 1 to 3 days to children who are suspected to have cancer.

    During visits, we take time to explain your child’s condition. We help you fully understand your treatment options and make the choices that are right for your family.

    Our child life specialists and social workers help your child and your family through the challenges of cancer. We connect you to community resources and support groups.

    At Seattle Children’s, we work with many children and families from around the Northwest and beyond. Whether you live nearby or far away, we can help with financial counseling, schooling, housing, transportation, interpreter services and spiritual care. Read about our services for patients and families.

Symptoms of Hodgkin Lymphoma

These symptoms may be caused by Hodgkin lymphoma or by another condition. Check with a doctor if your child has any of these:

  • Shortness of breath, breathing trouble, wheezing or high-pitched breathing. These may happen if your child’s thymus or lymph nodes in the chest are larger than normal.
  • Swelling in the head, neck, upper arms or chest. This may be caused by lymphoma pressing on the main vein that drains blood from these areas.
  • Trouble swallowing.
  • Swollen lymph nodes in the neck, underarm, chest, abdomen, pelvis or groin. Usually, lymph node symptoms appear slowly over a long period. Symptoms can be present for a year before doctors diagnose the disease.
  • Unexplained fever, weight loss or drenching night sweats. These are sometimes called B symptoms and may be signs that your child has a more advanced form of disease.
  • Itching all over

Diagnosing Hodgkin Lymphoma

To find out whether your child has Hodgkin lymphoma, the doctor will:

  • Do an exam to look for signs of the disease.
  • Ask about your child’s health.
  • Take a sample of tissue by surgery (biopsy) or use a needle to sample tissue or fluid around the lungs or organs in the belly.

Your doctor will want to take pictures of the inside of your child’s body (imaging studies). These help the doctor see enlarged lymph nodes, tumors or areas where cancer is active.

Imaging studies may include:

  • X-ray of the chest
  • CT (computed tomography) scan
  • Gallium scan
  • PET (positron emission tomography) scan

Your child’s doctor may do further tests to tell if the cancer has spread around the lymph system or to other parts of the body. This helps tell the stage of your child’s cancer, which affects their treatment.

The tests may include:

  • Complete blood count (CBC) – Tells how many cells of each type are moving through the bloodstream
  • Blood chemistry – Finds chemicals in the blood that may be signs of cancer
  • Bone marrow test – Shows if the disease has spread to the soft center of bones, where the body makes blood cells

Stages of Hodgkin Lymphoma

It is important to find out how far cancer has spread and what body parts it affects. This process is called staging.

Knowing the stage of your child’s cancer helps your doctor plan the right treatment. There are 4 stages of Hodgkin lymphoma:

  • Stage 1: Hodgkin lymphoma is in 1 group of lymph nodes.
  • Stage 2: Hodgkin lymphoma is in 2 or more groups of lymph nodes. All lymph nodes are either above or below the diaphragm. The diaphragm is the muscle that controls breathing and separates the chest and belly.
  • Stage 3: Hodgkin lymphoma is both above and below the diaphragm.
  • Stage 4: Hodgkin lymphoma is either:
    • Throughout 1 or more organs that are not in the lymph system.
    • Throughout 1 organ that is not in the lymph system AND in lymph nodes far from that organ.

Treating Hodgkin Lymphoma

Our Leukemia and Lymphoma Program offers the most advanced treatments for Hodgkin lymphoma in our region, including clinical trials of promising new therapies.

Our goal of treatment is to give your child or teen the best chance of a long and healthy life.

Your child’s doctor and health care team will suggest a treatment plan for your child based on:

  • Whether your child has classical Hodgkin lymphoma or nodular lymphocyte–predominant Hodgkin lymphoma.
  • The stage of the disease.
  • The size of tumors. Larger tumors are considered “bulky disease.”
  • Number of red blood cells and white blood cells.
  • Your child’s age and overall health.
  • Your family’s preferences.
  • How well cancer responds to early treatment with chemotherapy.

Hodgkin lymphoma needs more intense treatment if:

  • It is later stage
  • Tumors are larger (bulky disease)
  • Your child has fever, weight loss or night sweats (B symptoms)

  • For classical Hodgkin lymphoma, usually treatment starts with chemotherapy medicine. Your child will get chemotherapy in cycles, with a period of treatment followed by a rest period to let their body recover.

    After several cycles of treatment, your child will have a PET scan or CT scan to see how the cancer is responding to chemotherapy medicines. After that, many children have more chemotherapy and often radiation therapy.

    If your child’s disease does not respond well to treatment or returns after the first round of treatment, doctors may suggest high-dose chemotherapy and a stem cell transplant. Another option is targeted therapy.

  • Nodular lymphocyte–predominant Hodgkin lymphoma tends to grow more slowly and may be treated differently than classical Hodgkin lymphoma. Chemotherapy would be less intensive than for the classical form of this disease. Your doctor might also suggest surgery or radiation.

Types of Treatment

  • Most children with Hodgkin lymphoma are treated with chemotherapy using more than 1 medicine. Chemotherapy means giving medicines that go throughout your child’s body to kill cancer cells. Based on the type of disease and whether or where it has spread, your child’s doctors may also suggest radiation therapy.

    For Hodgkin lymphoma, chemotherapy is given by mouth or through a vein, which is called intravenous (IV). These medicines spread around the body through the bloodstream. They can help kill cancer cells:

    • In the blood
    • In the lymph system
    • That may have spread to other parts of the body

    Our patients receive chemotherapy at our hospital’s main campus in Seattle. Your child may get treatment at our infusion center as a day procedure or overnight in our Cancer Care Unit.

    See more about getting chemotherapy at Seattle Children’s.

  • Many children with Hodgkin lymphoma get radiation therapy along with chemotherapy to kill cancer cells and reduce the size of any tumors.

    Options include:

    • X-rays: A machine outside the body delivers strong beams of X-rays into the body.
    • Proton therapy: Unlike X-rays, proton beams stop once they reach their target.

    Before treatment, imaging tests help pinpoint the location of Hodgkin lymphoma so doctors give radiation only to the affected areas. We focus beams as precisely as possible to help limit damage to healthy tissue.

    Radiation can harm a young child’s developing nervous system and affect bone growth. Our radiation oncologist, Dr. Ralph Ermoian, is very experienced in caring for children. He helps your child’s team decide if radiation may be helpful and what type of radiation to use.

    Research has shown that children do not need radiation therapy if they have intermediate-risk Hodgkin lymphoma that responds well to chemotherapy. Now researchers are studying whether children with high-risk disease can be cured without radiation therapy. High-risk is stage 3 or 4 disease with B symptoms (fever, weight loss or night sweats).

    Learn more about Seattle Children’s Radiation Therapy Service.

  • Most children and teens with Hodgkin lymphoma do not have surgery, except for a biopsy to help diagnose the disease. During a biopsy, doctors usually remove a whole lymph node to check for cancer. In some cases, they may remove a small sample of tissue from another tumor site.

    Usually lymphoma spreads throughout the lymph system, so it’s rare to have a tumor in a specific location. Even if your child does have a tumor, doctors usually treat it with chemotherapy and radiation rather than surgery.

    Rarely, if a child has nodular lymphocyte–predominant Hodgkin lymphoma in only 1 node, they may be treated with surgery alone.

    Surgery is done at our hospital’s main campus in Seattle.

    Learn more about surgery to treat tumors at Seattle Children’s.

  • If your child’s lymphoma comes back after the first treatment, your doctor may suggest high doses of chemotherapy followed by a transplant of their own blood-forming (hematopoietic) stem cells.

    Doctors recommend a stem cell transplant if there are high-risk features when Hodgkin lymphoma comes back. These include:

    • Cancer returns to a location that has been treated with radiation
    • B symptoms
    • Cancer outside of lymph nodes
    • A short time between the last treatment and the return of lymphoma

    Before high-dose chemotherapy, doctors will remove stem cells from your child. The cells are frozen and stored. After chemotherapy is finished, doctors return the stem cells to your child’s body through a vein.

    High-dose chemotherapy treats tumors more effectively than lower-dose chemo. But the drugs damage the bone marrow’s ability to make new blood cells. That’s why your child needs a transplant of their stored healthy stem cells. A stem cell transplant using a child’s own cells is called autologous (aw-TAH-luh-gus).

    In rare cases, or if the Hodgkin lymphoma comes back after the transplant, doctors may transplant stem cells from a donor whose cells closely match your child’s. This type of stem cell transplant is called allogeneic (A-loh-jeh-NAY-ik).

    For either type of transplant, children may get radiation before the transplant or after they recover from the transplant.

    We do the transplants at Seattle Children’s, working closely with our partner, Fred Hutch.

    Learn more about the Pediatric Blood and Marrow Transplant Program.

  • Targeted therapy fights cancer by finding a specific substance (target), such as a protein on cancer cells or a substance that helps cancer grow. Different targeted therapies work in different ways. They may interfere with the cancer cells’ ability to grow, divide, make repairs or communicate with other cells.

    Some types of targeted therapy for Hodgkin lymphoma are being studied in clinical trials. Other targeted therapies may be part of standard treatment for your child if their cancer does not respond well to treatment or if it comes back.

    • Monoclonal antibodies are manmade versions of antibodies – immune system proteins that fight disease. When given to your child, the monoclonal antibody finds and attaches to the target and helps kill cancer cells.
    • Some monoclonal antibodies also carry chemotherapy drugs to cancer cells. They are called antibody drug conjugates. Brentuximab vedotin is an example.
    • Immune checkpoint inhibitors boost the immune system’s ability to find and kill cancer cells. This type of targeted therapy is used to treat some adults with Hodgkin lymphoma and is being studied to treat children with lymphoma.

  • Many children, adolescents and young adults with lymphoma participate in research as part of their medical treatment. Research studies of new drugs and other promising treatment approaches are called clinical or therapeutic trials.

    As a member of organizations like the Children’s Oncology Group (COG), Seattle Children’s can offer our patients the latest treatments being studied, including Phase 1 clinical trials. These early studies are not available at most treatment centers. The knowledge we gain through research improves the care we give all children with cancer.

    Clinical trials at Seattle Children’s include:

    • New chemotherapy medicine and targeted therapies for young people with advanced or recurrent Hodgkin lymphoma. The goal of this study is to increase cure rates and reduce after-effects of treatment.
    • Whether children with higher-risk disease can be effectively treated with less or no radiation.
    • A type of targeted therapy (immune checkpoint inhibitor) that may help the immune system kill cancer cells.
    • New ways to prepare children for transplant if they do not have a fully matched donor. Drs. Lauri Burroughs and Ann Woolfrey lead these studies.

    Learn more about cancer clinical trials at Seattle Children’s

Follow-up care

Follow-up care is important after treatment ends — no matter what type of treatment your child had. Your follow-up routine will depend on your child’s cancer and their treatments.

Most of our patients visit the Leukemia and Lymphoma Clinic at Seattle Children’s for follow-up care. If you live far from Seattle, your child may get some follow-up care from a cancer doctor in your own community.

During follow-up visits at Seattle Children’s, your child’s team will:

  • Look for any signs that cancer is returning
  • Check for effects that may happen months or years after treatment
  • Tell you and your child about any risk for other cancers and signs to watch for

Our Cancer Survivor Program provides long-term follow-up care to help young people stay healthy after being treated for cancer in childhood. Through our partnership in the Seattle Cancer Care Alliance, our patients who have had a stem cell transplant get care from the SCCA’s Long-Term Follow-Up program.

Contact Us

Contact the Cancer and Blood Disorders Center at 206-987-2106 for an appointment, a second opinion or more information.

To make an appointment, you can call us directly or get a referral from your child’s primary care provider. We encourage you to coordinate with your pediatrician or family doctor when coming to Seattle Children’s.

Providers, see how to refer a patient.