Cancers and Tumors

Non-Hodgkin Lymphoma Treatment

Your child can get the very latest treatments for non-Hodgkin lymphoma through the Leukemia and Lymphoma Program at Seattle Children's. Many children have more than one type of treatment.

Most children who have Hodgkin lymphoma or non-Hodgkin lymphoma are cured. The success of treatment depends on many factors, some of which are covered below.

As doctors find better treatments through clinical trials, the outlook for children with lymphoma will keep getting better.

Treatment Basics

The most common treatment for non-Hodgkin lymphoma is chemotherapy using more than one medicine. Doctors rarely use radiation except when the disease has spread to the central nervous system (brain and spinal cord) or testicles.

Seattle Children's offers all these treatments.

If the child's cancer recurs, doctors may suggest other treatments. These may include high-dose chemotherapy along with a hematopoietic cell, or stem cell, transplant, radiation or one of the new treatments that doctors are studying. We offer stem cell transplants and other new treatments at Children's.

The first round of treatment lasts from months to a couple of years, based on the type and extent of the disease.

Most children with non-Hodgkin lymphoma have disease that has spread to other places in the body at the time of diagnosis (stage III or stage IV disease).

Your child's doctor and healthcare team will suggest a treatment plan for your child based on the type of lymphoma your child has, the stage of the disease, whether and how many places it has spread and your child's overall health.

Non-Hodgkin Lymphoma Treatment Options

Chemotherapy

Chemotherapy means giving medicines that go throughout your child's body to kill cancer cells. If your child has non-Hodgkin lymphoma, your child's doctors will suggest chemotherapy.

Based on the type of disease and whether or where it has spread, your child's doctors may use radiation along with chemotherapy. Or they may suggest chemotherapy as the main treatment for your child's cancer.

Children can get chemotherapy through a vein, by mouth, as a shot into the spinal fluid or a shot in the leg. These medicines spread around the body through the bloodstream. They can help kill cancer cells that are in the blood as well as the lymph system and those that may have spread to other sites.

The exact mix of medicines and how long they are given depend on the type of disease your child has. Researchers are studying new mixes of medicines to find the best combination for each type of the disease.

For children with stage I or stage II non-Hodgkin lymphoma, chemotherapy may take between two and six months. This depends on the subtype of the disease. About 90% to 100% of children with non-Hodgkin lymphoma are cured with this treatment.

Children with stage III or stage IV non-Hodgkin lymphoma will need more intense chemotherapy treatment. This may last from six months to two years.

Doctors may divide the treatment into phases designed to kill as many cancer cells as possible. About 70% to 80% of these children are cured with this treatment.

If non-Hodgkin lymphoma has spread or may spread to your child's central nervous system (brain and spinal cord), your child may get chemotherapy as a shot into the spinal column.

Our patients receive chemotherapy at our hospital's main campus in Seattle.

Surgery

The lymph system is a network of vessels that carries fluid and cells around your child's body. Often lymphoma spreads throughout this system with no specific tumor site.

If your child does have a tumor, your child's doctors may suggest surgery.

The first surgery your child has may be a biopsy in which doctors remove a small sample of tumor cells to check for cancer.

In some cases during a biopsy surgery, doctors may try to remove a tumor that is confined to a very specific area.

Doctors often need to do surgery after the biopsy to remove the tumor. Even when doctors are able to remove the entire tumor, they may suspect or know that cancer cells are still in the child's body.

Doctors almost always use chemotherapy and sometimes radiation to kill remaining cancer cells.

Radiation

In non-Hodgkin lymphoma, doctors rarely use radiation. They may use it as an emergency treatment to reduce the size of a tumor in the chest if the tumor is in the way of breathing or blood flow from the heart.

They may also use radiation along with chemotherapy to treat non-Hodgkin lymphoma that has spread to the central nervous system (brain and spinal cord) or the testicles.

Radiation uses high-energy X-rays to kill cancer cells and reduce the size of tumors. A machine sends a dose of radiation through the outer structures, such as the skin and the skull, into deeper parts of the body.

Radiation can cause unpleasant side effects, such as nausea, sore throat or mild skin burning, or long-term problems, such as infertility or other cancers.

Radiation also can affect the way a child develops. So researchers are looking for ways to give radiation in smaller doses or to smaller areas or to use other treatments instead.

Our patients receive radiation therapy through our partner UW Medicine .

Learn more about Children's Radiation Therapy Service .

Hematapoietic cell transplant, or stem cell transplant

Children whose lymphoma comes back after treatment may have high doses of chemotherapy medicines combined with a hematpoietic cell, or stem cell, transplant.

The chemotherapy medicines are designed to kill cancer cells that remain in the child's body. Such high doses damage the bone marrow, so the marrow cannot make new stem cells that would become blood cells.

Doctors then give the child bone marrow or stem cells through a vein. This is called an infusion.

Sometimes doctors remove stem cells from the child before chemotherapy is given and store them so they can be returned to the child's body after chemotherapy. This is called an autologous stem cell transplant.

When stem cells come from a donor whose cells closely match the child's cells it is called an allogeneic stem cell transplant.

Most children whose non-Hodgkin lymphoma does not go away completely with the first round of chemotherapy or whose lymphoma comes back get other standard doses of chemotherapy.

After a few cycles of medicines, doctors remove stem cells from the child and store these cells. Once the cancer responds to the new chemotherapy, the child gets high-dose chemotherapy and then an infusion of her own stored stem cells.

In rare cases doctors may perform an allogeneic transplant, such as if the lymphoma comes back in the bone marrow or if it comes back after the autologous transplant.

Our patients who have a hematopoietic cell, or stem cell, transplant receive this care through Children's and our partner Fred Hutchinson Cancer Research Center .

Learn more about the Pediatric Blood and Marrow Transplant Program .

New Treatments for Non-Hodgkin Lymphoma

Researchers are running studies to find better treatments for children with lymphoma.

They are looking for the best combinations of chemotherapy medicines and ways to use chemotherapy and radiation together with better results. They are also looking for new types of cancer treatments.

Their main goals are to improve cure rates and reduce the risk of long-term effects from the disease and from the treatments.

The cancer doctors at Children's are active members of the Children's Oncology Group (COG) . COG is an international organization of childhood cancer specialists who conduct studies on many forms of childhood cancer. Many of our doctors serve on the COG lymphoma committees.

Studies are going on for the different subtypes of non-Hodgkin lymphoma. There are also studies of new treatments for non-Hodgkin lymphoma that recurs or does not respond to standard first treatments.

The new treatments being studied include agents called monoclonal antibodies. These are designed to target the lymphoid tissue where lymphoma cells arise.

Many of our patients with lymphoma take part in clinical trials . These research studies give children the chance to get the very latest treatment options being studied - options that are not offered at all treatment centers.

Your child's doctor will talk with you in detail about any new treatment that might be a match for your child. Then you can decide whether you want to try this option.

Read more about research at Seattle Children's and about follow-up after treatment ends .