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    Childhood Hodgkin Lymphoma Treatment (PDQ®): Treatment - Patient Information [NCI]

    Childhood Hodgkin Lymphoma Treatment (PDQ®): Treatment - Patient Information [NCI]

    This information is produced and provided by the National Cancer Institute (NCI). The information in this topic may have changed since it was written. For the most current information, contact the National Cancer Institute via the Internet web site at http://cancer.gov or call 1-800-4-CANCER.

    Childhood Hodgkin Lymphoma Treatment

    General Information About Childhood Hodgkin Lymphoma

    Childhood Hodgkin lymphoma is a disease in which malignant (cancer) cells form in the lymph system.

    Childhood Hodgkin lymphoma is a type of cancer that develops in the lymph system, which is part of the body's immune system. The lymph system is made up of the following:

    • Lymph: Colorless, watery fluid that travels through the lymph system and carries white blood cells called lymphocytes. Lymphocytes protect the body against infections and the growth of tumors.
    • Lymph vessels: A network of thin tubes that collect lymph from different parts of the body and return it to the bloodstream.
    • Lymph nodes: Small, bean-shaped structures that filter lymph and store white blood cells that help fight infection and disease. Lymph nodes are located along the network of lymph vessels found throughout the body. Clusters of lymph nodes are found in the underarm, pelvis, neck, abdomen, and groin.
    • Spleen: An organ that makes lymphocytes, filters the blood, stores blood cells, and destroys old blood cells. The spleen is on the left side of the abdomen near the stomach.
    • Thymus: An organ in which lymphocytes grow and multiply. The thymus is in the chest behind the breastbone.
    • Tonsils: Two small masses of lymph tissue at the back of the throat. The tonsils make lymphocytes.
    • Bone marrow: The soft, spongy tissue in the center of large bones. Bone marrow makes white blood cells, red blood cells, and platelets.

    Lymph system; drawing shows the lymph vessels and lymph organs including the lymph nodes, tonsils, thymus, spleen, and bone marrow. One inset shows the inside structure of a lymph node and the attached lymph vessels with arrows showing how the lymph (clear fluid) moves into and out of the lymph node. Another inset shows a close up of bone marrow with blood cells.
    Anatomy of the lymph system, showing the lymph vessels and lymph organs including lymph nodes, tonsils, thymus, spleen, and bone marrow. Lymph (clear fluid) and lymphocytes travel through the lymph vessels and into the lymph nodes where the lymphocytes destroy harmful substances. The lymph enters the blood through a large vein near the heart.

    Because lymph tissue is found throughout the body, Hodgkin lymphoma can start in almost any part of the body and spread to almost any tissue or organ in the body.

    Lymphomas are divided into two general types: Hodgkin lymphoma and non-Hodgkin lymphoma. (See the PDQ summary on Childhood Non-Hodgkin Lymphoma Treatment for more information.)

    Hodgkin lymphoma often occurs in teenagers (age 15?19). The treatment for children and teenagers may be different than treatment for adults. (See the PDQ summary on Adult Hodgkin Lymphoma Treatment for more information.)

    There are two types of childhood Hodgkin lymphoma.

    The two types of childhood Hodgkin lymphoma are:

    • Classical Hodgkin lymphoma.
    • Nodular lymphocyte-predominant Hodgkin lymphoma.

    Classical Hodgkin lymphoma is divided into four subtypes, based on how the cancer cells look under a microscope:

    • Lymphocyte-rich classical Hodgkin lymphoma.
    • Nodular sclerosis Hodgkin lymphoma.
    • Mixed cellularity Hodgkin lymphoma.
    • Lymphocyte-depleted Hodgkin lymphoma.

    Epstein-Barr virus infection can affect the risk of childhood Hodgkin lymphoma.

    Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn't mean that you will not get cancer. Talk with your child's doctor if you think your child may be at risk. Risk factors for childhood Hodgkin lymphoma include the following:

    • Being infected with the Epstein-Barr virus.
    • Being infected with the human immunodeficiency virus (HIV).
    • Having certain inherited diseases of the immune system.
    • Having a personal history of mononucleosis ("mono").

    Being exposed to common infections before the age of 5 may decrease the risk of Hodgkin lymphoma in children because of the effect it has on the immune system.

    Possible signs of childhood Hodgkin lymphoma include swollen lymph nodes, fever, night sweats, and weight loss.

    These and other symptoms may be caused by childhood Hodgkin lymphoma or by other conditions. Check with a doctor if your child has any of the following problems:

    • Painless, swollen lymph nodes in the neck, chest, underarm, or groin.
    • Fever for no known reason.
    • Weight loss for no known reason.
    • Night sweats.
    • Fatigue.
    • Anorexia.
    • Itchy skin.
    • Pain in the lymph nodes after drinking alcohol.

    Fever, weight loss, and night sweats are called B symptoms.

    Tests that examine the lymph system are used to detect (find) and diagnose childhood Hodgkin lymphoma.

    The following tests and procedures may be used:

    • Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient's health habits and past illnesses and treatments will also be taken.
    • CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, such as the neck, chest, abdomen, or pelvis, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
    • PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
    • Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
    • Complete blood count (CBC): A procedure in which a sample of blood is drawn and checked for the following:
      • The number of red blood cells, white blood cells, and platelets.
      • The amount of hemoglobin (the protein that carries oxygen) in the red blood cells.
      • The portion of the blood sample made up of red blood cells.

      Complete blood count (CBC); left panel shows blood being drawn from a vein on the inside of the elbow using a tube attached to a syringe; right panel shows a laboratory test tube with blood cells separated into layers: plasma, white blood cells, platelets, and red blood cells.
      Complete blood count (CBC). Blood is collected by inserting a needle into a vein and allowing the blood to flow into a tube. The blood sample is sent to the laboratory and the red blood cells, white blood cells, and platelets are counted. The CBC is used to test for, diagnose, and monitor many different conditions.
    • Blood chemistry studies: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that makes it.
    • Sedimentation rate: A procedure in which a sample of blood is drawn and checked for the rate at which the red blood cells settle to the bottom of the test tube.
    • Lymph node biopsy: The removal of all or part of a lymph node. The lymph node may be removed during a thoracoscopy, mediastinoscopy, or laparoscopy. One of the following types of biopsies may be done:
      • Excisional biopsy: The removal of an entire lymph node.
      • Incisional biopsy: The removal of part of a lymph node.
      • Core biopsy: The removal of tissue from a lymph node using a wide needle.
      • Fine-needle aspiration (FNA) biopsy: The removal of tissue from a lymph node using a thin needle.

      A pathologist views the tissue under a microscope to look for cancer cells, especially Reed-Sternberg cells. Reed-Sternberg cells are common in classical Hodgkin lymphoma.


      Reed-Sternberg cell; photograph shows normal lymphocytes compared with a Reed-Sternberg cell.
      Reed-Sternberg cell. Reed-Sternberg cells are large, abnormal lymphocytes that may contain more than one nucleus. These cells are found in Hodgkin lymphoma.

      The following test may be done on tissue that was removed:

      • Immunophenotyping: A test in which the cells in a sample of blood or bone marrow are looked at under a microscope to find out what type of malignant (cancerous) lymphocytes are causing the lymphoma.

    Certain factors affect prognosis (chance of recovery) and treatment options.

    The prognosis (chance of recovery) and treatment options depend on the following:

    • The stage of the cancer.
    • The size of the tumor.
    • The type of Hodgkin lymphoma.
    • Whether there are B symptoms at diagnosis.
    • Certain features of the cancer cells.
    • Whether there are too many white blood cells or too few red blood cells at diagnosis.
    • How well the tumor responds to initial treatment with chemotherapy.
    • Whether the cancer is newly diagnosed or has recurred (come back).

    The treatment options also depend on:

    • The child's age and gender.
    • The risk of long-term side effects.

    Most children and teenagers with newly diagnosed Hodgkin lymphoma can be cured.

    Stages of Childhood Hodgkin Lymphoma

    After childhood Hodgkin lymphoma has been diagnosed, tests are done to find out if cancer cells have spread within the lymph system or to other parts of the body.

    The process used to find out if cancer has spread within the lymph system or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. Treatment is based on the stage and other factors that affect prognosis. The following tests and procedures may be used in the staging process:

    • CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, such as the neck, chest, abdomen, or pelvis, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
    • PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
    • MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI). An MRI of the abdomen and pelvis may be done.
    • Bone marrow aspiration and biopsy: The removal of bone marrow, blood, and a small piece of bone by inserting a hollow needle into the hipbone or breastbone. A pathologist views the bone marrow, blood, and bone under a microscope to look for abnormal cells.
      Bone marrow aspiration and biopsy; drawing shows a patient lying face down on a table and a Jamshidi needle (a long, hollow needle) being inserted into the hip bone. Inset shows the Jamshidi needle being inserted through the skin into the bone marrow of the hip bone.
      Bone marrow aspiration and biopsy. After a small area of skin is numbed, a Jamshidi needle (a long, hollow needle) is inserted into the patient's hip bone. Samples of blood, bone, and bone marrow are removed for examination under a microscope.

    There are three ways that cancer spreads in the body.

    The three ways that cancer spreads in the body are:

    • Through tissue. Cancer invades the surrounding normal tissue.
    • Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.
    • Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.

    When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.

    Stages of childhood Hodgkin lymphoma may include A, B, E, and S.

    Childhood Hodgkin lymphoma may be described as follows:

    • A: The patient does not have fever, weight loss, or night sweats.
    • B: The patient has B symptoms (fever, weight loss, and night sweats).
    • E: Cancer is found in an organ or tissue that is not part of the lymph system but which may be next to an involved area of the lymph system.
    • S: Cancer is found in the spleen.

    The following stages are used for childhood Hodgkin lymphoma:

    Stage I

    Stage I childhood Hodgkin lymphoma; drawing shows cancer in one lymph node group above the diaphragm. An inset shows a lymph node with a lymph vessel, an artery, and a vein. Lymphoma cells containing cancer are shown in the lymph node.
    Stage I childhood Hodgkin lymphoma. Cancer is found in one or more lymph nodes in one lymph node group. In stage IE (not shown), cancer is found outside the lymph nodes in one organ or area.

    Stage I is divided into stage I and stage IE.

    • Stage I: Cancer is found in one of the following places in the lymph system:
      • One or more lymph nodes in one lymph node group.
      • Waldeyer's ring.
      • Thymus.
      • Spleen.
    • Stage IE: Cancer is found outside the lymph system in one organ or area.

    Stage II

    Stage II is divided into stage II and stage IIE.


    • Stage II childhood Hodgkin lymphoma; drawing shows cancer in lymph node groups above and below the diaphragm. An inset shows a lymph node with a lymph vessel, an artery, and a vein. Lymphoma cells containing cancer are shown in the lymph node.
      Stage II childhood Hodgkin lymphoma. Cancer is found in two or more lymph node groups, and both are either above (a) or below (b) the diaphragm. Stage II: Cancer is found in two or more lymph node groups either above or below the diaphragm (the thin muscle below the lungs that helps breathing and separates the chest from the abdomen).

    • Stage IIE childhood Hodgkin lymphoma; drawing shows cancer in one lymph node group above the diaphragm and in the left lung. An inset shows a lymph node with a lymph vessel, an artery, and a vein. Lymphoma cells containing cancer are shown in the lymph node.
      Stage IIE childhood Hodgkin lymphoma. Cancer is found in one or more lymph node groups above or below the diaphragm and outside the lymph nodes in a nearby organ or area (a). Stage IIE: Cancer is found in one or more lymph node groups either above or below the diaphragm and outside the lymph nodes in a nearby organ or area.

    Stage III

    Stage III childhood Hodgkin lymphoma; drawing shows cancer in lymph node groups above and below the diaphragm, in the left lung, and in the spleen. An inset shows a lymph node with a lymph vessel, an artery, and a vein. Lymphoma cells containing cancer are shown in the lymph node.
    Stage III childhood Hodgkin lymphoma. Cancer is found in one or more lymph node groups above and below the diaphragm (a). In stage IIIE, cancer is found in lymph node groups above and below the diaphragm and outside the lymph nodes in a nearby organ or area (b). In stage IIIS, cancer is found in lymph node groups above and below the diaphragm (a) and in the spleen (c). In stage IIIS plus E, cancer is found in lymph node groups above and below the diaphragm, outside the lymph nodes in a nearby organ or area (b), and in the spleen (c).

    Stage III is divided into stage III, stage IIIE, stage IIIS, and stage IIIE,S.

    • Stage III: Cancer is found in lymph node groups above and below the diaphragm (the thin muscle below the lungs that helps breathing and separates the chest from the abdomen).
    • Stage IIIE: Cancer is found in lymph node groups above and below the diaphragm and outside the lymph nodes in a nearby organ or area.
    • Stage IIIS: Cancer is found in lymph node groups above and below the diaphragm, and in the spleen.
    • Stage IIIE,S: Cancer is found in lymph node groups above and below the diaphragm, outside the lymph nodes in a nearby organ or area, and in the spleen.

    Stage IV

    Stage IV childhood Hodgkin lymphoma; drawing shows cancer in the liver, the left lung, and in one lymph node group below the diaphragm. The brain and pleura are also shown. One inset shows cancer spreading through lymph nodes and lymph vessels to other parts of the body. Lymphoma cells containing cancer are shown inside one lymph node. Another inset shows cancer cells in the bone marrow.
    Stage IV childhood Hodgkin lymphoma. Cancer is found outside the lymph nodes throughout one or more organs (a); or outside the lymph nodes in one organ and has spread to lymph nodes far away from that organ (b); or in the lung, liver, or bone marrow.

    In stage IV, the cancer:

    • is found outside the lymph nodes throughout one or more organs, and may be in lymph nodes near those organs; or
    • is found outside the lymph nodes in one organ and has spread to areas far away from that organ; or
    • is found in the lung, liver, bone marrow, or cerebrospinal fluid (CSF). The cancer has not spread to the lung, liver, bone marrow, or CSF from nearby areas.

    Untreated Hodgkin lymphoma is divided into risk groups.

    Untreated childhood Hodgkin lymphoma is divided into risk groups based on the stage, size of the tumor, and whether the patient has "B" symptoms (fever, weight loss, or night sweats). The risk group is used to plan treatment.

    • Low-risk childhood Hodgkin lymphoma.
    • Intermediate-risk childhood Hodgkin lymphoma.
    • High-risk childhood Hodgkin lymphoma.

    Primary Refractory / Recurrent Hodgkin Lymphoma in Children and Adolescents

    Primary refractory Hodgkin lymphoma is lymphoma that continues to grow or spread during treatment. Recurrent Hodgkin lymphoma is cancer that has recurred (come back) after it has been treated. The lymphoma may come back in the lymph system or in other parts of the body, such as the lungs, liver, bones, or bone marrow.

    Treatment Option Overview

    There are different types of treatment for children with Hodgkin lymphoma.

    Different types of treatment are available for children with Hodgkin lymphoma. Some treatments are standard 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.

    Because cancer in children is rare, taking part in a clinical trial should be considered. Some clinical trials are open only to patients who have not started treatment.

    Children with Hodgkin lymphoma should have their treatment planned by a team of health care providers with expertise 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 pediatric health care providers who are experts in treating children with Hodgkin lymphoma and who specialize in certain areas of medicine. These may include the following specialists:

    • Medical oncologist /hematologist.
    • Pediatric surgeon.
    • Radiation oncologist.
    • Endocrinologist.
    • Pediatric nurse specialist.
    • Rehabilitation specialist.
    • Psychologist.
    • Social worker.

    The treatment of Hodgkin lymphoma in teenagers and young adults may be different than the treatment for children. Some teenagers and young adults are treated with an adult regimen.

    Five 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, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). Combination chemotherapy is treatment using more than one anticancer drug.

    The way the chemotherapy is given depends on the risk group. For example, children with low-risk Hodgkin lymphoma receive fewer cycles of treatment, fewer anticancer drugs, and lower doses of anticancer drugs than children with high-risk lymphoma.

    See Drugs Approved for 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.

    Radiation therapy may be given, based on the child's risk group and chemotherapy regimen. External radiation therapy is used for childhood Hodgkin lymphoma. The radiation is given only to the lymph nodes or other areas with cancer.

    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. One type of targeted therapy being used in the treatment of childhood Hodgkin lymphoma is monoclonal antibody therapy.

    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.

    Surgery

    Surgery may be done to remove as much of the tumor as possible for localized nodular lymphocyte -predominant childhood Hodgkin lymphoma.

    High-dose chemotherapy with stem cell transplant

    High-dose chemotherapy with stem cell transplant is a way of giving high doses of chemotherapy and replacing blood -forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow 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 body's blood cells.

    New types of treatment are being tested in clinical trials.

    This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI Web site.

    Proton beam radiation therapy

    Proton-beam therapy is a type of high-energy, external radiation therapy that uses streams of protons (small, positively-charged particles of matter) to make radiation. This type of radiation therapy is being studied for girls with Hodgkin lymphoma, to help reduce the risk of breast cancer from radiation to the chest.

    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. This is sometimes called re-staging.

    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.

    For patients who receive chemotherapy alone, a PET scan may be done 3 weeks or more after treatment ends. For patients who receive radiation therapy last, a PET scan should not be done until 8 to 12 weeks after treatment.

    Treatment Options for Children and Adolescents with Hodgkin Lymphoma

    A link to a list of current clinical trials is included for each treatment section. For some types or stages of cancer, there may not be any trials listed. Check with your child's doctor for clinical trials that are not listed here but may be right for your child.

    Low-Risk Childhood Hodgkin Lymphoma

    Treatment of low-risk childhood Hodgkin lymphoma is combination chemotherapy. Sometimes radiation therapy is also given to the areas with cancer. For localized nodular lymphocyte predominant childhood Hodgkin lymphoma, surgery may be the only treatment needed when the tumor can be completely removed.

    Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage I childhood Hodgkin lymphoma and stage II childhood Hodgkin 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. General information about clinical trials is available from the NCI Web site.

    Intermediate-Risk Childhood Hodgkin Lymphoma

    Treatment of intermediate-risk childhood Hodgkin lymphoma is combination chemotherapy. Radiation therapy may also be given to the areas with cancer.

    Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage I childhood Hodgkin lymphoma, stage II childhood Hodgkin lymphoma, stage III childhood Hodgkin lymphoma and stage IV childhood Hodgkin 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. General information about clinical trials is available from the NCI Web site.

    High-Risk Childhood Hodgkin Lymphoma

    Treatment of high-risk childhood Hodgkin lymphoma is higher dose combination chemotherapy. Radiation therapy may also be given to the areas with cancer.

    Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage III childhood Hodgkin lymphoma and stage IV childhood Hodgkin 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. General information about clinical trials is available from the NCI Web site.

    Treatment Options for Primary Refractory / Recurrent Hodgkin Lymphoma in Children and Adolescents

    Treatment of primary refractory or recurrent childhood Hodgkin lymphoma may include the following:

    • Chemotherapy, monoclonal antibody therapy, or a combination of these therapies.
    • High-dose chemotherapy with stem cell transplant using the patient's own stem cells. Low-dose radiation therapy also may be given after transplant.
    • High-dose chemotherapy with stem cell transplant using a donor's stem cells.

    Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with recurrent/refractory childhood Hodgkin 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. General information about clinical trials is available from the NCI Web site.

    Late Effects from Childhood and Adolescent Hodgkin Lymphoma Treatment

    Children and teenagers may have treatment-related side effects that appear months or years after treatment for Hodgkin lymphoma. Because of these late effects on health and development, regular follow-up exams are important. Late effects may include problems with the following:

    • Development of sex and reproductive organs.
    • Fertility (ability to have children).
    • Thyroid, heart, or lungs.
    • An increased risk of developing a second primary cancer.
    • Bone and muscle growth and development.
    • Teeth, gums, and salivary glands.

    For female survivors of Hodgkin lymphoma, there is an increased risk of breast cancer. This risk depends on the amount of radiation therapy they received during treatment and the chemotherapy regimen used. The risk of breast cancer is decreased when female survivors receive radiation therapy to the ovaries. It is suggested that these patients have a mammogram once a year starting 8 years after treatment or at age 25 years, whichever is later. Female survivors of childhood Hodgkin lymphoma who have breast cancer have an increased risk of dying from the disease compared to patients with no history of Hodgkin lymphoma who have breast cancer.

    The risk of these long-term side effects will be considered when treatment decisions are made. (See the PDQ summary on Late Effects of Treatment for Childhood Cancer for more information.)

    To Learn More About Childhood Hodgkin Lymphoma

    For more information from the National Cancer Institute about childhood Hodgkin lymphoma, see the following:

    • What You Need to Know About? Hodgkin Lymphoma
    • Understanding Cancer Series: The Immune System
    • Drugs Approved for Hodgkin Lymphoma
    • Targeted Cancer Therapies
    • Understanding Cancer Series: Targeted Therapies (Advances in Targeted Therapies and Targeted Therapies for Lymphoma)
    • Understanding Cancer Series: Blood Stem Cell Transplants
    • Bone Marrow Transplantation and Peripheral Blood Stem Cell Transplantation

    For more childhood cancer information and other general cancer resources, see the following:

    • What You Need to Know About? Cancer
    • Childhood Cancers
    • CureSearch for Children's Cancer
    • Late Effects of Treatment for Childhood Cancer
    • Adolescents and Young Adults with Cancer
    • Young People with Cancer: A Handbook for Parents
    • Care for Children and Adolescents with Cancer
    • Understanding Cancer Series: Cancer
    • Cancer Staging
    • Coping with Cancer: Supportive and Palliative Care
    • Questions to Ask Your Doctor About Cancer
    • Cancer Library
    • Information for Survivors/Caregivers/Advocates

    Changes to This Summary (01 / 30 / 2013)

    The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

    Editorial changes were made to this summary.

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    PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at NCI's Web site. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.

    PDQ contains cancer information summaries.

    The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions provide current and accurate cancer information.

    Images in the PDQ summaries are used with permission of the author(s), artist, and/or publisher for use within the PDQ summaries only. Permission to use images outside the context of PDQ information must be obtained from the owner(s) and cannot be granted by the National Cancer Institute. Information about using the illustrations in the PDQ summaries, along with many other cancer-related images, are available in Visuals Online, a collection of over 2,000 scientific images.

    The PDQ cancer information summaries are developed by cancer experts and reviewed regularly.

    Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary ("Date Last Modified") indicates the time of the most recent change.

    PDQ also contains information on clinical trials.

    A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." In the United States, about two-thirds of children with cancer are treated in a clinical trial at some point in their illness.

    Listings of clinical trials are included in PDQ and are available online at NCI's Web site. Descriptions of the trials are available in health professional and patient versions. For additional help in locating a childhood cancer clinical trial, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237).

    The PDQ database contains listings of groups specializing in clinical trials.

    The Children's Oncology Group (COG) is the major group that organizes clinical trials for childhood cancers in the United States. Information about contacting COG is available on the NCI Web site or from the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237).

    Last Revised: 2013-01-30


    If you want to know more about cancer and how it is treated, or if you wish to know about clinical trials for your type of cancer, you can call the NCI's Cancer Information Service at 1-800-422-6237, toll free. A trained information specialist can talk with you and answer your questions.


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