The immune system helps protect the body from infection and disease.
The lymph system is made up of:
Lymph tissue is also found in other parts of the body such as the stomach, thyroid gland, brain, and skin.
Non-Hodgkin lymphoma can begin in B lymphocytes, T lymphocytes, or natural killer cells.
There are two general types of lymphomas: Hodgkin lymphoma and non-Hodgkin lymphoma. This summary is about the treatment of childhood non-Hodgkin lymphoma. Learn more about Childhood Hodgkin Lymphoma Treatment.
Treatment of non-Hodgkin lymphoma is different for children and adults. For information about treatment of adults, see:
The type of lymphoma is determined by how the cells look under a microscope. The three major types of childhood non-Hodgkin lymphoma are:
Aggressive mature B-cell non-Hodgkin lymphomas include:
Burkitt lymphoma has been linked to infection with the Epstein-Barr virus (EBV). Burkitt lymphoma is more common in White people than in Hispanic people. Burkitt lymphoma is diagnosed when a sample of tissue is checked and a certain change to the MYC gene is found.
Lymphoblastic lymphoma is a type of lymphoma that mainly affects T-cell lymphocytes. It usually forms in the mediastinum (the area between the lungs). This causes trouble breathing, wheezing, trouble swallowing, or swelling of the head and neck. It may spread to lymph nodes, bone, bone marrow, skin, the CNS, abdominal organs, and other areas. Lymphoblastic lymphoma is a lot like acute lymphoblastic leukemia (ALL).
Anaplastic large cell lymphoma is a type of lymphoma that mainly affects T-cell lymphocytes. It usually forms in the lymph nodes, skin, or bone, and sometimes forms in the gastrointestinal tract, lung, tissue that covers the lungs, and muscle. Patients with anaplastic large cell lymphoma have a receptor, called CD30, on the surface of their T cells. In many children, anaplastic large cell lymphoma is marked by changes in the ALK gene that makes a protein called anaplastic lymphoma kinase. A pathologist checks for these cell and gene changes to help diagnose anaplastic large cell lymphoma.
Some types of childhood non-Hodgkin lymphoma are less common. These include:
A risk factor is anything that increases the chance of getting a disease. Not every child with one or more of these risk factors will develop NHL. And it will develop in some children who don't have a known risk factor.
Some immune system problems may increase the risk of childhood NHL. These immune system problems include:
If lymphoma or lymphoproliferative disease is linked to a weakened immune system from certain inherited diseases, HIV infection, a transplant, or medicines given after a transplant, the condition is called lymphoproliferative disease associated with immunodeficiency. The different types of lymphoproliferative disease associated with immunodeficiency include:
Talk with your child's doctor if you think your child may be at risk.
The symptoms of childhood non-Hodgkin lymphoma depend on the where the cancer forms in the body. It's important to check with your child's doctor if your child has:
These symptoms may be caused by problems other than non-Hodgkin lymphoma. The only way to know is to see your child's doctor.
If your child has symptoms that suggest non-Hodgkin lymphoma, the doctor will need to find out if these are due to cancer or another problem. The doctor will ask when the symptoms started and how often your child has been having them. They will also ask about your child's personal and family health history and do a physical exam. Depending on these results, they may recommend other tests. If your child is diagnosed with non-Hodgkin lymphoma, the results of the tests will help plan treatment.
The tests used to diagnose and stage non-Hodgkin lymphoma may include:
One of the following types of biopsies may be done:
The procedure used to remove the sample of tissue depends on where the tumor is in the body:
If cancer is found, the following tests may be done to study the cancer cells:
You may want to get a second opinion to confirm your child's diagnosis and treatment plan. If you seek a second opinion, you will need to get medical test results and reports from the first doctor to share with the second doctor. The second doctor will review the pathology report, slides, and scans. This doctor may agree with the first doctor, suggest changes to the treatment plan, or provide more information about your child's cancer.
To learn more about choosing a doctor and getting a second opinion, visit Finding Cancer Care. You can contact NCI's Cancer Information Service via chat, email, or phone (both in English and Spanish) for help finding a doctor or hospital that can provide a second opinion. For questions you might want to ask at your child's appointments, visit Questions to Ask Your Doctor About Cancer.
If your child has been diagnosed with non-Hodgkin lymphoma, you likely have questions about how serious the cancer is and your child's chances of survival. The likely outcome or course of a disease is called prognosis.
The prognosis depends on:
No two people are alike, and responses to treatment can vary greatly. Your child's cancer care team is in the best position to talk with you about your child's prognosis.
Cancer stage describes the extent of cancer in the body, such as the size of the tumor, whether it has spread, and how far it has spread from where it first formed. It's important to know the stage of non-Hodgkin lymphoma to plan the best treatment.
For a description of the tests and procedures used to diagnose non-Hodgkin lymphoma, see General Information.
In stage I childhood non-Hodgkin lymphoma, cancer is found:
No cancer is found in the abdomen or mediastinum (area between the lungs).
In stage II childhood non-Hodgkin lymphoma, cancer is found:
In stage III childhood non-Hodgkin lymphoma, cancer is found:
In stage IV childhood non-Hodgkin lymphoma, cancer is found in the bone marrow, brain, or cerebrospinal fluid. Cancer may also be found in other parts of the body.
Refractory non-Hodgkin lymphoma is cancer that does not respond to initial treatment.
Recurrent non-Hodgkin lymphoma is cancer that has come back after treatment. It may come back in the lymph system or in other parts of the body.
You and your child's care team will work together to decide treatment. Many factors will be considered, such as where the cancer is located, the type of non-Hodgkin lymphoma, whether the cancer is newly diagnosed or has come back, and your child's age and overall health.
Your child's treatment plan will include information about the tumor, the goals of treatment, treatment options, and possible side effects. It will be helpful for you to talk with your child's care team before treatment begins about what to expect. For help every step of the way, visit our booklet, Children with Cancer: A Guide for Parents.
A pediatric oncologist, a doctor who specializes in treating children with cancer, oversees treatment of non-Hodgkin lymphoma. The pediatric oncologist works with other health care providers who are experts in treating children with cancer and also specialize in certain areas of medicine. Other specialists may include:
Surgery may be done to remove as much of the tumor as possible for some types of childhood non-Hodgkin lymphoma. After the doctor removes all the cancer that can be seen at the time of surgery, patients may be given chemotherapy to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.
Chemotherapy (also called chemo) uses drugs to stop the growth of cancer cells. Chemotherapy either kills the cells or stops them from dividing. Chemotherapy may be given alone or with other types of treatment.
Chemotherapy for childhood non-Hodgkin lymphoma is taken by mouth or injected into a vein. When given this way, the drugs enter the bloodstream and can reach cancer cells throughout the body. Chemotherapy for childhood non-Hodgkin lymphoma is also placed directly into the cerebrospinal fluid (intrathecal chemotherapy), an organ, or a body cavity such as the abdomen. When given this way, the drugs mainly affect cancer cells in those areas.
Intrathecal chemotherapy may be used to treat childhood non-Hodgkin lymphoma that has spread, or may spread, to the brain. When used to lessen the chance cancer will spread to the brain, it is called CNS prophylaxis. Intrathecal chemotherapy is given in addition to chemotherapy by mouth or vein. Higher than usual doses of chemotherapy may also be used as CNS prophylaxis.
Chemotherapy drugs used alone or in combination to treat non-Hodgkin lymphoma in children include:
Other chemotherapy drugs not listed here may also be used.
The way the chemotherapy is given depends on the type and stage of the cancer being treated.
Learn more about Chemotherapy to Treat Cancer.
Radiation therapy uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. External radiation therapy uses a machine outside the body to send radiation toward the area of the body with cancer. External radiation therapy may be used to treat childhood non-Hodgkin lymphoma that has spread, or may spread, to the brain and spinal cord. It may also be used to treat cutaneous T-cell lymphoma (mycosis fungoides).
Learn more about External Beam Radiation Therapy for Cancer and Radiation Therapy Side Effects.
High doses of chemotherapy are given to kill cancer cells. This treatment destroys healthy cells, including blood-forming cells. Stem cell transplant is a treatment to replace the blood-forming cells. 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 patient completes chemotherapy, the stored stem cells are thawed and given to the patient through an infusion. These reinfused stem cells grow into (and restore) the body's blood cells. The donor stem cells may also find and kill any cancer cells left in the body.
Targeted therapy uses drugs or other substances to block the action of specific enzymes, proteins, or other molecules involved in the growth and spread of cancer cells. Types of targeted therapy used to treat non-Hodgkin lymphoma in children include:
Learn more about Targeted Therapy to Treat Cancer.
Retinoids are drugs related to vitamin A. Retinoid therapy with bexarotene is used to treat several types of cutaneous T-cell lymphoma.
Steroids are hormones made naturally in the body. They can also be made in a laboratory and used as drugs. Steroid therapy that is applied to the skin is used to treat cutaneous T-cell lymphoma. Dexamethasone and prednisone are steroids used with other drugs to treat certain types of lymphoma.
Antibiotics are drugs used to treat infections and cancer caused by bacteria or other microorganisms. Antibiotics have been used to treat mucosa-associated lymphoid tissue (MALT) lymphoma. Treatment with antibiotic therapy has been mostly studied in adults.
Phototherapy uses a drug and a certain type of laser light to kill cancer cells. A drug that is not active until it is exposed to light is injected into a vein. The drug collects more in cancer cells than in normal cells. For cancer in the skin, laser light is shined onto the skin and the drug becomes active and kills the cancer cells. Phototherapy is used in the treatment of cutaneous T-cell lymphoma.
Watchful waiting is closely monitoring a patient's condition without giving any treatment until signs or symptoms appear or change.
Immunotherapy helps a person's immune system fight cancer. Types of immunotherapy include:
Learn more about Immunotherapy to Treat Cancer.
Cancer treatments can cause side effects. Which side effects your child might have depends on the type of treatment they receive, the dose, and how their body reacts. Talk with your child's treatment team about which side effects to look for and ways to manage them.
To learn more about side effects that begin during treatment for cancer, visit Side Effects.
Problems from cancer treatment that begin 6 months or later after treatment and continue for months or years are called late effects. Late effects of cancer treatment may include:
Some late effects may be treated or controlled. It is important to talk with your child's doctors about the effects cancer treatment can have on your child. Learn more about Late Effects of Treatment for Childhood Cancer.
For some children, joining a clinical trial may be an option. There are different types of clinical trials for childhood cancer. For example, a treatment trial tests new treatments or new ways of using current treatments. Supportive care and palliative care trials look at ways to improve quality of life, especially for those who have side effects from cancer and its treatment.
You can use the clinical trial search to find NCI-supported cancer clinical trials accepting participants. The search allows you to filter trials based on the type of cancer, your child's age, and where the trials are being done. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.
Learn more about clinical trials, including how to find and join one, at Clinical Trials Information for Patients and Caregivers.
As your child goes through treatment, they will have follow-up tests or check-ups. Some tests that were done to diagnose or stage the cancer may be repeated 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.
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).
For information about the treatments listed below, see Treatment Option Overview.
Treatment of newly diagnosed Burkitt lymphoma may include:
For information about the treatments listed below, see Treatment Option Overview.
Treatment of recurrent or refractory Burkitt lymphoma may include:
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.
For information about the treatments listed below, see Treatment Option Overview.
Treatment of newly diagnosed diffuse large B-cell lymphoma may include:
For information about the treatments listed below, see Treatment Option Overview.
Treatment of recurrent or refractory diffuse large B-cell lymphoma may include:
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.
For information about the treatments listed below, see Treatment Option Overview.
Treatment of newly diagnosed primary mediastinal B-cell lymphoma may include combination chemotherapy, prednisone, targeted therapy (rituximab), and sometimes radiation therapy.
For information about the treatments listed below, see Treatment Option Overview.
Treatment of recurrent or refractory primary mediastinal B-cell lymphoma may include targeted therapy (pembrolizumab).
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.
For information about the treatments listed below, see Treatment Option Overview.
Lymphoblastic lymphoma may be classified as the same disease as acute lymphoblastic leukemia (ALL). Treatment of lymphoblastic lymphoma may include:
For information about the treatments listed below, see Treatment Option Overview.
Treatment of recurrent or refractory lymphoblastic lymphoma may include:
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.
For information about the treatments listed below, see Treatment Option Overview.
Treatment of anaplastic large cell lymphoma may include:
For information about the treatments listed below, see Treatment Option Overview.
Treatment of recurrent or refractory anaplastic large cell lymphoma may include:
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.
For information about the treatments listed below, see Treatment Option Overview.
Treatment of lymphoproliferative disease in children and adolescents with weakened immune systems may include:
For information about the treatments listed below, see Treatment Option Overview.
Treatment of non-Hodgkin lymphoma associated with DNA repair defect syndromes in children may include chemotherapy.
For information about the treatments listed below, see Treatment Option Overview.
Treatment with highly active antiretroviral therapy or HAART (a combination of antiretroviral drugs) lowers the risk of non-Hodgkin lymphoma in patients infected with HIV.
Treatment of HIV-related non-Hodgkin lymphoma (NHL) in children may include chemotherapy with or without targeted therapy (rituximab).
For information about the treatments listed below, see Treatment Option Overview.
Treatment of post-transplant lymphoproliferative disease may include:
For information about the treatments listed below, see Treatment Option Overview.
Treatment of follicular lymphoma in children may include:
For children whose cancer has certain changes in the genes, treatment is similar to that given to adults with follicular lymphoma. For information about the treatment of follicular lymphoma in adults, visit Non-Hodgkin Lymphoma.
For information about the treatments listed below, see Treatment Option Overview.
Treatment of marginal zone lymphoma (including mucosa-associated lymphoid tissue [MALT] lymphoma) in children may include:
For information about the treatments listed below, see Treatment Option Overview.
Treatment of primary CNS lymphoma in children may include chemotherapy and targeted therapy (rituximab).
For information about the treatments listed below, see Treatment Option Overview.
Treatment of peripheral T-cell lymphoma in children may include:
For information about the treatments listed below, see Treatment Option Overview.
Treatment of subcutaneous panniculitis-like T-cell lymphoma in children may include:
Treatment of cutaneous anaplastic large cell lymphoma may include surgery, radiation therapy, or both.
For information about the treatments listed below, see Treatment Option Overview.
In children, treatment of mycosis fungoides may include:
For information about the treatments listed below, see Treatment Option Overview.
In children, treatment of lymphomatoid papulosis may include:
For more information from the National Cancer Institute about childhood non-Hodgkin lymphoma, visit:
For more childhood cancer information and other general cancer resources, visit:
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PDQ® Pediatric Treatment Editorial Board. PDQ Childhood Non-Hodgkin Lymphoma Treatment. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: https://www.cancer.gov/types/lymphoma/patient/child-nhl-treatment-pdq. Accessed <MM/DD/YYYY>. [PMID: 26389294]
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