Chemotherapy for childhood Hodgkin lymphoma

Chemotherapy uses anticancer (cytotoxic) drugs to destroy cancer cells. It is the main treatment for childhood Hodgkin lymphoma (HL). The healthcare team will consider the type of HL, stage, tumour size (bulkiness) and 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 usually a systemic therapy. This means that the drugs travel through the blood to reach and destroy cancer cells all over the body. The drugs may be given by mouth (orally) or through a needle in a vein (intravenously). If your child needs intense chemotherapy, a special device called a central venous catheter may be used to safely give the drugs. It is usually placed during surgery at the start of chemotherapy and left in place until treatment is finished.

Assessing the response to chemotherapy both at the start of chemotherapy and after chemotherapy is completed is important for determining prognosis and planning treatment. Response assessment uses imaging such as CT, MRI and PET scans to measure a tumour’s response (whether or not it decreases in size).

Interim response assessment is done following the first few chemotherapy cycles. The results help plan the strength (intensity) of additional chemotherapy cycles in order to lessen late effects but maintain effective treatment.

End of chemotherapy response assessment may be used to decide whether radiation therapy is needed. End of chemotherapy response assessment is usually done at least 3 weeks after chemotherapy is finished.

Chemotherapy drugs used to treat childhood HL include:

• cyclophosphamide (Procytox)
• doxorubicin (Adriamycin)
• vincristine (Oncovin)
• bleomycin (Blenoxane)
• procarbazine hydrochloride (Matulane)
• dacarbazine
• etoposide (Vepesid, VP-16)
• vinblastine
• prednisone
• dexamethasone (Decadron, Dexasone)
• methotrexate
• cytarabine (Cytosar)
• cisplatin

These drugs are usually given in combination to treat childhood HL. When different drugs are given together, they are more effective than any single drug alone.

If childhood HL does not respond to drugs used in earlier treatments or if it comes back (recurs), other drugs that may be used are:

• ifosfamide (Ifex)
• vinorelbine (Navelbine)
• gemcitabine (Gemzar)
• carboplatin (Paraplatin, Paraplatin AQ)
• etoposide
• dexamethasone
• cisplatin
• cytarabine

Side effects can happen with any type of treatment for childhood HL, but every child’s experience is different. Some children have many side effects. Other children have only a few side effects.

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 and the child’s overall health. Some common side effects of chemotherapy drugs used for childhood HL are:

• bone marrow suppression causing low platelet count, low white blood cell count and anemia
• hair loss
• sore mouth or throat
• loss of appetite
• weight gain
• nausea and vomiting
• fatigue
• diarrhea
• constipation
• skin problems
• pain at the injection site
• peripheral nerve damage

Other side effects can develop months or years after treatment for childhood HL. Find out more about late effects of treatments for childhood HL.

Tell your child’s 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.

Details on specific drugs change regularly. Find out more about sources of drug information and where to get details on specific drugs.

Find out more about chemotherapy and side effects of chemotherapy. To make the decisions that are right for you, ask your healthcare team questions about chemotherapy.