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Childhood non-Hodgkin lymphoma

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Treatments for childhood anaplastic large cell lymphoma

The following are treatment options for childhood anaplastic large cell lymphoma (ALCL). The healthcare team will suggest treatments based on your child’s needs and work with you to develop a treatment plan. Treatments are often based on the stage.

Sometimes childhood ALCL develops only in the skin. This is called cutaneous ALCL. It may be treated with surgery, radiation therapy or both. Sometimes chemotherapy with low-dose methotrexate is also given.

First-line therapy for childhood ALCL

First-line therapy is the first or most common treatment used. The following may be used as first-line therapy for ALCL.

Chemotherapy

Chemotherapy is the main treatment for childhood ALCL. How long chemotherapy is given and the combinations of drugs given depend on whether the ALCL is ALK-positive or ALK-negative and the stage of the cancer. Chemotherapy for low-stage (stage I and II) ALCL may be given for 3–6 months. Chemotherapy for high-stage (stage III and IV) ALCL may be given for 9–12 months.

Chemotherapy drugs are given in different combinations based on different treatment plans (called protocols). The most common chemotherapy drugs used in combinations for ALCL are:

  • doxorubicin (Adriamycin)
  • cyclophosphamide (Cytoxan, Procytox)
  • vincristine (Oncovin)
  • prednisone
  • methotrexate
  • mercaptopurine (Purinethol, 6-MP)
  • cytarabine (Cytosar, Ara-C)
  • dexamethasone (Decadron, Dexasone)
  • etoposide (Vepesid, VP-16)
  • ifosfamide (Ifex)
  • leucovorin (folinic acid)
  • hydrocortisone
  • vinblastine (Velbe)
  • daunorubicin (Cerubidine, daunomycin)
  • L-asparaginase (Kidrolase)
  • 6-thioguanine (Lanvis, 6-TG)

Intrathecal chemotherapy may be given to prevent spread of NHL to the brain and spinal cord (called the central nervous system, or CNS) or to treat NHL that has spread to the CNS. This means that the drugs are given directly into the cerebrospinal fluid (CSF) around the brain and spinal cord. Intrathecal chemotherapy can include 1 to 3 of the following drugs:

  • methotrexate
  • cytarabine
  • hydrocortisone

Recurrent childhood ALCL

Treatments for recurrent, or relapsed, childhood ALCL may include more intense chemotherapy, targeted therapy or an allogeneic or autologous stem cell transplant.

Some chemotherapy drugs and combinations used for recurrent ALCL include:

  • dexamethasone, etoposide, cisplatin (Platinol AQ), cytarabine and L-asparaginase
  • ifosfamide, carboplatin (Paraplatin, Paraplatin AQ) and etoposide
  • vinblastine
  • crizotinib (Xalkori)
  • brentuximab vedotin (Adcetris)

Clinical trials

Many children with childhood ALCL will be treated in a clinical trial that is tailored to the risk group or stage of their disease. The clinical trial protocol, or plan, outlines the treatments used (such as chemotherapy), as well as the drugs and dosages used. Find out more about clinical trials.

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