Pediatric Lymphomas: Managing Side Effects

Pictured: Jennifer Ogilvie Pediatric nurse Jennifer Ogilvie and other members of the care team help children and young adults cope with treatment side effects.

Fast-growing lymphoma cells are very similar to fast-growing normal cells in the body. Therefore, lymphoma treatments can also harm normal cells in the process of destroying the disease.

For more than 35 years, our pediatrics team has selected approaches that minimize and treat the unavoidable physical side effects of cancer therapy. The most significant side effect of lymphoma treatment is low counts of red blood cells, white blood cells, and platelets. These and other side effects are usually temporary and improve after the dose of the medication is reduced or after treatment has ended.

We also have experts who can help patients and families manage the anxiety, stress, and other psychosocial challenges that emerge when a child is ill.

Preventing Infection

To help prevent and treat infections that result from low white blood cell counts associated with lymphoma and its treatments, we make sure our patients are appropriately treated with antibiotics. Our doctors discovered a therapy for severely low levels of a type of white blood cell, which reduces the risk of infection.1,2 The therapy, called granulocyte colony-stimulating factor (GCSF), is now used around the world.

In addition, to protect your child from exposure to infections, we might request that he or she stay in an isolated room, and that visitors wear gowns, masks, and gloves as preventive measures. It is essential for visitors with any sign of cold or other infection to avoid contact with a child who is undergoing treatment for lymphoma.

Managing Low Platelet & Red Blood Cell Counts

Low platelet counts can mean that your child bruises and bleeds easily, so we can help teach you injury-prevention techniques. We might recommend that your child receive a transfusion of platelets to reduce the risk of bleeding, or that female patients who are at the age of menstruation receive hormones to temporarily stop their periods. It is very important for children who have low platelet counts to avoid medications containing aspirin or ibuprofen because these medications prevent platelets from working properly and can increase the risk of bleeding.

Low red blood cell counts can cause anemia, which can be treated with a blood transfusion to relieve symptoms, including weakness, shortness of breath, and elevated heart rate.

At Memorial Sloan Kettering, we have our own Blood Bank and Donor Room. Our platelet and blood supplies are as safe as possible. However, it is important to minimize the number of transfusions. We encourage you to bring in friends and family to donate blood. If the donated blood is healthy and is of the same blood type as your child, we can arrange to direct these donations to your child.

Coping with Hair Loss & Other Physical Side Effects

Another type of fast-growing cell affected by lymphoma treatments is cells in the hair follicles. Unfortunately, most children will temporarily lose their hair two to three weeks after starting chemotherapy. This can be distressing to parents and patients, especially teenagers. You or your child will have the opportunity to speak with former patients about the process of losing and regaining their hair. We can also help you find wigs, hats, and scarves.

Other side effects from some chemotherapy medications can include:

  • fatigue
  • nausea and vomiting
  • diarrhea
  • change in the taste of foods
  • abnormal sensations in the fingers and toes
  • poor balance
  • painful mouth ulcers/inflammation of mucous membranes in the mouth and gastrointestinal tract, which can be managed with oral care routines, pain medications, and special diets

After a lasting remission period, delayed effects of therapy can occasionally be seen in various organs, such as the liver, heart, lungs, ovaries, or testes. Chemotherapy can sometimes cause infertility or the development of a second cancer. These are very rare effects, but the team monitors each patient closely to identify and address long-term issues.

Dealing with Emotional Effects

The initial course of treatment, physical side effects, stress of hospitalization, lack of sleep, and homesickness can be very difficult for children and families — especially for siblings who may not understand the sudden switch in focus from the family's usual daily activities to the needs of the child with lymphoma.

Patients frequently regress, act younger than their age, and act out. Patients receiving steroids as part of chemotherapy can have temporary personality changes or become moody and irritable. In addition, children and young adults often find it difficult — even overwhelming — to carry on their normal activities.

Our team at Memorial Sloan Kettering will do everything in our power to minimize the discomfort, sadness, and stress that are common during treatment. Social workers, psychiatrists, psychologists, play therapists, child life specialists, and volunteers are available to help you and your child cope with the ups and downs.

We can also arrange for you to speak with patients who have experienced a similar process and have successfully overcome their disease. There is strength in numbers, and knowing you are not alone may provide comfort. In addition, clergy are available to listen and provide spiritual support and guidance. Social workers can also help with financial issues related to treatment.

Even though a child or teen is being treated for cancer, he or she does not need to fall behind on schoolwork. We have a branch of the New York City Public School System, called P.S. 401, assigned to Memorial Sloan Kettering. Teachers are available daily to help inpatient and outpatient children keep up with their studies during the treatment and recovery process.

1Heath JA, Steinherz PG, Altman A, Sather H, Jhanwar S,Halpern S, Pieters R, Shah N, Steinherz L, Tannous R, Terry W, Trigg ME. Human granulocyte colony-stimulating factor in children with high-risk acute lymphoblastic leukemia: A Children's Cancer Group Study. J Clin Onc 2003;21:1612-1617. [PubMed Abstract]

2Welte K, Platzer E, Lu L, Gabrilove JL, Levi E, Mertelsmann R, Moore MA. Purification and biochemical characterization of human pluripotent hematopoietic colony-stimulating factor. Proc Natl Acad Sci U S A. 1985 Mar;82(5):1526-30. [PubMed Abstract]