Childhood non-Hodgkin lymphoma

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Treatments for childhood diffuse large B-cell lymphoma

The following are treatment options for childhood diffuse large B-cell lymphoma (DLBCL).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 or risk group.

First-line therapy for childhood DLBCL

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

Surgery

In general, a surgical or open biopsy is done by a surgeon to make the correct diagnosis. Rarely, if the lymphoma is only in one area of the body, such as the abdomen, surgery may be done to remove it before chemotherapy is given.

Chemotherapy

Chemotherapy is the main treatment for childhood DLBCL. How long chemotherapy is given depends on the risk group and the treatment plan (called the protocol). It may be given for 9 weeks to 6 months for stage I or II DLBCL and for 6 to 8 months for stage III or IV DLBCL.

Chemotherapy drugs are given in different combinations based on different treatment plans. The most common chemotherapy drugs used in combinations for DLBCL include:

  • cyclophosphamide (Cytoxan, Procytox)
  • vincristine (Oncovin)
  • prednisone
  • cyclophosphamide
  • cytarabine (Cytosar, Ara-C)
  • etoposide (Vepesid, VP-16)
  • methotrexate
  • prednisolone
  • doxorubicin (Adriamycin)
  • hydrocortisone
  • dexamethasone (Decadron, Dexasone)
  • daunorubicin (Cerubidine, daunomycin)
  • L-asparaginase (Kidrolase)
  • mercaptopurine (Purinethol, 6-MP)
  • 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 DLBCL

Treatments for recurrent, or relapsed, childhood DLBCL lymphoma may include more intense chemotherapy, with or without targeted therapy, or an allogeneic or autologous stem cell transplant.

Some chemotherapy combinations used for recurrent childhood DLBCL include:

  • dexamethasone, etoposide, cisplatin (Platinol AQ), cytarabine and asparaginase
  • ifosfamide (Ifex), carboplatin (Paraplatin, Paraplatin AQ), etoposide and rituximab (Rituxan)

Clinical trials

Many children with childhood DLBCL 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 or targeted therapy), as well as the drugs and dosages used. Find out more about clinical trials.

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