Chemotherapy for childhood non-Hodgkin lymphoma
Chemotherapy uses anticancer, or cytotoxic, drugs to destroy cancer cells. It is the main treatment for childhood non-Hodgkin lymphoma (NHL). The healthcare team will consider the type of NHL, stage, risk group, as well as your child’s personal needs, to plan the drugs, doses and schedules of chemotherapy. Your child may also receive other treatments.
Chemotherapy is given for different reasons. Your child may have chemotherapy to:
- destroy cancer cells in the body
- prevent the spread of cancer cells to the brain and spinal cord (called the central nervous system, or CNS)
- prepare for a stem cell transplant
- relieve pain or control the symptoms of advanced NHL (called palliative chemotherapy)
Systemic chemotherapy drugs used for childhood NHL
Chemotherapy is usually a systemic therapy. This means that the drugs travel through the bloodstream to reach and destroy cancer cells all over the body, including those that may have broken away from the primary tumour. The drugs may be given by mouth, by a needle in a vein (intravenous injection) or by a needle into a muscle (intramuscular injection). Usually a special device called a central venous catheter may be used to safely give the drugs. It is usually placed in the operating room at the start of chemotherapy and left in place until treatment is finished. There are different types of central venous catheters, but your healthcare team will recommend the type that is most suitable for your child’s treatment. Find out more about central venous catheter.
Drugs used in systemic chemotherapy are given in different combinations based on different protocols. When different drugs are given together, they are more effective than giving any single drug alone. The most common systemic chemotherapy drugs used in combinations to treat childhood NHL are:
- cyclophosphamide (Cytoxan, Procytox)
- doxorubicin (Adriamycin)
- vincristine (Oncovin)
- cytarabine (Cytosar, Ara-C)
- dexamethasone (Decadron, Dexasone)
- daunorubicin (daunomycin, Cerubidine)
- asparaginase (Kidrolase)
- etoposide (Vepesid, VP-16)
- mercaptopurine (Purinethol, 6-MP)
- ifosfamide (Ifex)
- leucovorin (folinic acid)
- thioguanine (Lanvis, 6-TG)
- vinblastine (Velbe)
Intrathecal chemotherapy drugs used for childhood NHL
Chemotherapy may also be given as a regional therapy, which means that it is given to a specific area of the body. For childhood NHL, regional chemotherapy is given to the CNS by intrathecal chemotherapy. This means that the drugs are given directly into the cerebrospinal fluid (CSF). Intrathecal chemotherapy is given through a lumbar puncture, or spinal tap, into the space containing the cerebrospinal fluid.
Intrathecal chemotherapy may be given to prevent NHL from spreading to the CNS or to treat NHL that has spread to the CNS. Chemotherapy is given directly into the CSF because many drugs cannot cross the body’s blood-brain barrier. This barrier helps protect the brain by filtering the blood that flows to it.
Intrathecal chemotherapy can include 1 to 3 of the following drugs:
Chemotherapy for resistant or recurrent childhood NHL
NHL that does not respond to drugs used in earlier treatments is called resistant NHL. If it comes back after treatment, it is called recurrent, or relapsed, NHL. The following drug combinations may be used to treat resistant or recurrent childhood NHL:
- dexamethasone, etoposide, cisplatin (Platinol AQ), cytarabine and asparaginase
- ifosfamide, carboplatin (Paraplatin, Paraplatin AQ) and etoposide
- ifosfamide, carboplatin, etoposide and rituximab (Rituxan)
Side effects can happen with any type of treatment for childhood NHL, but every child’s experience is different. Some children have many side effects. Other children have few or none at all.
Chemotherapy may cause side effects because it can damage healthy cells as it kills cancer cells. Side effects can develop any time during, immediately after or a few days or weeks after chemotherapy. Sometimes late side effects develop months or years after chemotherapy. Most side effects go away on their own or can be treated, but some side effects may last a long time or become permanent.
It is hard to say exactly which side effects a child will have, how long they will last and when the child will recover. A child’s body seems to handle chemotherapy better than an adult’s body. Children usually have less severe side effects and will often recover from them faster than adults.
Side effects of chemotherapy will depend mainly on the type of drug or drugs given, the dose, how the drugs are given (for example, systemic or intrathecal chemotherapy) and the child’s overall health. Some common side effects of chemotherapy drugs used for childhood NHL are:
- tumour lysis syndrome
- bone marrow suppression causing low platelet count, low white blood cell count and anemia
- hair loss
- sore mouth or throat
- loss of appetite and taste changes
- nausea and vomiting
- weight gain or loss
- skin problems
- peripheral nerve damage
As therapy for certain types of NHL can be quite intensive, long hospital stays are sometimes required to minimize the risk of serious or life-threatening infections as a result of an impaired immune system.
Other side effects can develop months or years after treatment for childhood NHL. Find out more about late effects for childhood NHL.
Tell the healthcare team if your child has these side effects or others you think might be from chemotherapy. The sooner you tell them of any problems, the sooner they can suggest ways to help your child deal with them.
Information about specific cancer drugs
The following websites have information about specific drugs used to treat cancer in children.
Cancer Care Ontario (CCO) Drug Formulary is a searchable database of drugs used to treat cancer.
British Columbia Cancer Agency (BCCA) Drug Index (Professional) is a list of drugs used to treat cancer and includes basic information about uses and doses.
Questions to ask about chemotherapy
The fluid in the cavities in and around the brain and spinal cord that helps protect and cushion these organs.
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Great progress has been made
Some cancers, such as thyroid and testicular, have survival rates of over 90%. Other cancers, such as pancreatic, brain and esophageal, continue to have very low survival rates.