Pediatric Lymphomas: Treatment

Memorial Sloan Kettering doctors have pioneered therapies — such as chemotherapy regimens and peripheral stem cell transplants — that have improved survival rates in children who have lymphomas, including those who are newly diagnosed and those who have tumors that return after the initial round of treatment. Our experts also performed one of the first studies showing that routine radiation treatment is not necessary for all children with non-Hodgkin lymphoma.1,2 Today, the disease-free survival rate is greater than 90 percent for children with Hodgkin lymphoma and more than 80 percent for children with non-Hodgkin lymphoma.

For each child who comes to Memorial Sloan Kettering, our doctors develop a personalized lymphoma treatment strategy based on information including:

  • age of the child
  • initial symptoms
  • subtype and stage of disease
  • whether the disease is bulky and extensive
  • whether the disease has spread outside the lymph nodes
  • how quickly the disease disappears after the start of therapy

Our team cares for each child using the most-effective treatment or combination of treatments to maximize the benefit, while minimizing the risk of long-term side effects. The goal of treatment is to put lymphoma into remission, in which the treatment kills nearly all of the abnormal cells, diagnostic scans appear normal, and symptoms subside.

Chemotherapy

Initial treatment for a child or young adult with lymphoma typically involves the use of chemotherapy medications, which kill the lymphoma cells and stop abnormal white blood cells from growing. Your child will receive a combination of several chemotherapy medications. Each medication targets lymphoma cells in a different way, in case the cells are resistant to any one of the treatments.

Almost all of our chemotherapy is administered on an outpatient basis in the Pediatric Day Hospital. The duration of therapy varies for each child, based on the type and stage of the lymphoma.

Children and young adults with low-stage lymphoma are generally treated with a less intensive combination of chemotherapy drugs. Children with high-stage disease are treated with more-intensive chemotherapy. These varying levels of chemotherapy ensure that children with any stage of disease will have a similar chance of a cure. We also take care in selecting chemotherapy agents that limit the risk of causing a second cancer to develop in later years.

In particular, children with lymphoblastic lymphoma are treated similar to children with acute lymphoblastic leukemia.

Radiation therapy

We tailor radiation therapy to each child's particular characteristics. If a child responds well to chemotherapy, radiation therapy may not provide an added treatment benefit. For most children and young adults with non-Hodgkin lymphoma, radiation therapy is not necessary.

However, many children with Hodgkin lymphoma benefit from the addition of low-dose radiation therapy in the area of the affected lymph node(s) after chemotherapy is completed. This is often necessary for extensive or bulky areas of lymphoma. Radiation therapy is administered daily, Monday through Friday, over a period of three to four weeks.

Innovative Treatment Strategies

Experts at Memorial Sloan Kettering have spearheaded the development and study of new treatment strategies for children and young adults who have lymphoma that returns after initial therapy. These include medications directed at the tumors, known as targeted agents, and medications that pinpoint molecules expressed by the tumors.

If very high dose chemotherapy is necessary to treat a recurrence of childhood lymphoma, our experts can use a strategy known as peripheral stem cell transplantation, in which young, healthy blood cells, known as stem cells, are used to replenish blood cells damaged by chemotherapy. When we know that a child has a very high risk for relapse — based on the type of lymphoma, its location, and other characteristics — we collect stem cells from a child's circulating blood after he or she achieves a first remission. We freeze these cells and store them in case they are needed in the future, as cells collected after many cycles of chemotherapy may not be as healthy as those collected soon after diagnosis.

For children who are not responding to therapies that are known to be effective, our team can often offer new treatments through clinical trials.

1Mora J, Filippa DA, Qin J, et al. Lymphoblastic lymphoma of childhood and the LSA2-L2 protocol. The 30-year experience at Memorial Sloan Kettering Cancer Center. Cancer 2003;98:1283-1291. [PubMed Abstract]

2Sposto R, Meadows AT, Chilcote RR, Steinherz PG, Kieldsberg C, Kadin ME, Krailo MD, Termuhlen AM, Morse M, Siegel SE. Comparison of long-term outcome of children and adolescents with disseminated Non-Lymphoblastic Non-Hodgkin Lymphoma treated with COMP or Daunomycin-COMP: A report from the Children's Cancer Group. Med Pediatr Oncol 2001;37:432-441. [PubMed Abstract]