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How We Treat Childhood Non-Hodgkin Lymphoma (NHL)

  • Children with non-Hodgkin lymphoma are treated at Dana-Farber/Boston Children's through the Childhood Lymphoma Program in our Childhood Hematologic Malignancy Center. Dana-Farber/Boston Children's offers internationally renowned care for children with cancers of the blood and immune system.

    Dana-Farber/Boston Children's also offers a wide array of support services and programs for pediatric patients and their families during and after cancer treatment.

    The first major factor in deciding on a treatment strategy for non-Hodgkin lymphoma is through determining the specific type of lymphoma. The next important consideration is whether the cancer is localized to a specific part of the body (low stage; stage I or II) or has spread to different parts of the body (advanced stage; stage III or IV). Generally, stronger treatment is needed for successful treatment of advanced stage lymphoma.

    Non-Hodgkin lymphoma treatment may include:

    • Chemotherapy: By far the most common treatment for non-Hodgkin lymphoma is chemotherapy. Chemotherapy is drug treatment that works by interfering with the cancer cells' ability to grow or reproduce. Several different chemotherapy drugs are combined to provide the most effective treatment for the lymphoma. Commonly used drugs in the treatment of lymphoma are cyclophosphamide, doxorubicin, vincristine, prednisone, and methotrexate, among others. Different chemotherapy drugs work in different ways. Chemotherapy may be given by mouth, by injection into the muscle or directly into the vein (IV), or as a direct injection into the spinal fluid through a needle (lumbar puncture). Chemotherapy into the spinal fluid is commonly used as part of the treatment of NHL in children.
    • Targeted therapy: Antibodies, immune cell therapies, and drugs that target lymphoma cells directly or help the body's own immune system to attack the cancer have become important tools in fighting lymphoma. Rituximab is an antibody that targets CD20 on mature B-cell lymphomas. Brentuximab is an antibody-chemotherapy combination that targets lymphomas with CD30 expression, such as anaplastic large cell lymphoma. Other types of immunotherapy are currently being investigated in the treatment of lymphoma.
    • CAR T-cell therapy: Pediatric B-cell lymphomas, such as Burkitt lymphoma and diffuse large B-cell lymphoma, are usually cured with chemotherapy. However, for patients with lymphoma that does not respond to chemotherapy or that comes back after initial treatment, a cure can be difficult to achieve. CAR (chimeric antigen receptor) T-cell therapy is a promising new treatment for these challenging cases of pediatric non-Hodgkin lymphoma. It works by modifying the patient's own T-cells, a normal part of the body's immune system, to make cells that hunt and destroy the abnormal cancer cells.
    • Stem cell transplant: When a lymphoma is completely resistant to initial treatment or recurs despite initial treatment, high dose chemotherapy followed by a stem cell transplant may be a good treatment option. In a stem cell transplant for NHL, the transplanted bone marrow is usually the patient's own (autologous), rather than someone else's (allogeneic).
    • Radiation therapy: High-energy rays (radiation) from a specialized machine are used to damage or kill cancer cells and shrink tumors. This type of therapy is not commonly used to treat non-Hodgkin lymphoma in children.
    • Surgery: This option may be required to biopsy the tumor to make an accurate diagnosis, or to confirm that the tumor has responded well to treatment, but it usually does not have a role in the treatment of pediatric NHL.

    The lymphoma specialists at Dana-Farber/Boston Children's determine the best approach to treatment for your child's unique situation, based on the type of lymphoma, the extent of the disease, your child's medical condition, your child's and your family's preferences, and the most up-to-date medical knowledge about lymphoma therapies.

    Clinical Trials

    For many children with cancer, clinical trials (research studies evaluating new treatment approaches) provide state-of-the-art treatments and new opportunities for cure. We offer many lymphoma clinical trials, and your child may be eligible to participate in one. Participation in a clinical trial is optional and is never a requirement to receive treatment.

    In addition to launching our own clinical trials, we also offer trials available through collaborative groups such as the Children's Oncology Group (COG), the Therapeutic Advances in Childhood Leukemia and Lymphoma (TACL) group, and the Pediatric Oncology Experimental Therapeutics Investigators' Consortium (POETIC). Dana-Farber/Boston Children's clinicians comprise the New England Phase I Center of the Children's Oncology Group.

    We have new treatments under investigation, both for newly diagnosed lymphomas and for lymphomas that have come back after initial treatment. New and experimental treatments include monoclonal antibody therapies, antibody-drug conjugates and bispecific antibodies that specifically target tumor cells; small molecule inhibitors that interfere with the way cancer cells grow; checkpoint inhibitors that activate the body's own immune system to fight the cancer; and selective inhibitors of nuclear export (SINE) that prevent tumor cells from escaping cell death. Clinical trials to investigate the biology of each child's lymphoma are available and may help find targets of therapy unique to that lymphoma.

    Learn more about clinical trials for pediatric cancer.

    Long-term Outlook for Children with Non-Hodgkin Lymphoma

    The long-term outlook for children with non-Hodgkin lymphoma is excellent. More than 80 percent of children are cured and can resume a normal life, returning to school, social activities, and athletics, typically within a year after diagnosis.

    Along with survivorship come numerous complex issues: the long-term effects of treatment and the risk of second cancers, as well as social and psychological concerns. For these reasons, survivors of childhood non-Hodgkin lymphoma should receive regular follow-up monitoring and care.

    In addition to meeting with our pediatric oncologists, your child may see one of our endocrinologists, cardiologists, neurologists, neuro-psychologists, or integrative therapy specialists. We also offer patient and family education, psychosocial assessment, genetic counseling, reproductive counseling, and opportunities to speak with other childhood cancer survivors.

    Since 1993, physicians, nurses, researchers, and psychologists in our pediatric cancer survivorship programs at the David B. Perini Jr. Quality of Life Clinic at Dana-Farber have helped thousands of childhood cancer survivors, treated at Dana-Farber/Boston Children's and at other hospitals in New England and elsewhere, to manage these long-term challenges of surviving cancer.