Childhood Hodgkin lymphoma

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Side effects of chemotherapy for childhood HL

Side effects can happen with any type of treatment for childhood Hodgkin lymphoma (HL), but every child’s experience is different. Some children have many side effects. Others 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.

Side effects of chemotherapy will depend mainly on:

  • the type of drug or drugs given
  • the dose
  • how the drug is given (for example, by mouth or through a needle)
  • the child’s overall health

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.

Tell the healthcare team if your child has these side effects or others you think might be from chemotherapy. The sooner you tell them about any problems, the sooner they can suggest ways to help your child deal with them.

Bone marrow suppression

Bone marrow suppression is the most common and most serious side effect of chemotherapy. Chemotherapy drugs used to treat childhood HL usually affect the bone marrow and can cause bone marrow suppression and low blood cell counts.

  • A low white blood cell count is called neutropenia. It increases the risk of infection.
  • A low platelet count is called thrombocytopenia. It increases the risk of bruising and bleeding.
  • A low red blood cell count is called anemia. It causes fatigue, paleness and malaise, which is a general feeling of illness.

Low blood cell counts occur because of chemotherapy’s effect on the bone marrow, where blood cells are made. Blood counts often reach their lowest level about 7–14 days after chemotherapy.

The doctor will monitor the child’s blood cell counts regularly to determine if the child needs a blood transfusion. If blood cell counts remain low and do not recover within the expected time following chemotherapy, the dose of chemotherapy may need to be adjusted or the chemotherapy may have to be stopped temporarily.

Find out more about bone marrow suppression and low blood cell counts.

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Hair loss

Hair loss is also called alopecia. Hair loss and a sensitive scalp are common side effects of chemotherapy. This is because anticancer drugs often kill the normal cells responsible for hair growth. Hair loss can vary greatly among children being treated for cancer. Some lose only some of their hair or their hair just thins out. Others quickly lose every hair on their entire body.

Hair loss can begin a few days or 2–3 weeks after chemotherapy starts. Hair usually starts to grow back before treatment ends or within 3 months after the end of treatment. When the hair comes back, it may be a slightly different colour and texture than it was before.

To protect the child’s head from the sun, the child should wear a hat and sunscreen while outside. If the child doesn’t lose their hair, use mild shampoos and hair products to avoid scalp irritation.

Find out more about hair loss.

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Sore mouth and throat

Chemotherapy can cause a sore mouth or throat. It can also irritate the gums and make them bleed. This is because the tissue that lines the mouth and digestive tract is made up of cells that divide quickly. Because chemotherapy targets rapidly dividing cells, it damages these tissues.

A sore mouth occurs about a week (5–14 days) after some types of chemotherapy are started. It often improves on its own a few weeks after treatment is finished.

A sore mouth makes it hard for a child to eat and drink. Painful mouth sores, ulcers and mouth infections can also develop. Thorough, regular mouth care may help prevent a sore mouth and reduce infection. The healthcare team will give instructions on how often to clean and rinse the mouth and what to use. Pain medicines or special oral solutions may be needed to relieve pain.

Find out more about sore mouth or throat.

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Loss of appetite

Nausea and vomiting, fatigue or a buildup of waste products as cancer cells die can cause loss of appetite. Loss of appetite can occur days to weeks after chemotherapy. Some chemotherapy drugs can cause temporary changes in taste and smell, which can make foods seem less appetizing. Some children may lose interest in food completely and don’t eat. This can lead to weight loss and malnutrition. Maintaining good nutrition during and after chemotherapy is important to help a child recover from treatment.

Find out more about loss of appetite and taste changes.

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Weight gain

Some chemotherapy regimens that use steroids, such as prednisone, may lead to an increased appetite or weight gain. There may be ways to limit weight gain from steroids, but a certain amount of weight gain is unavoidable.

Check with your child’s doctor and dietitian for tips to help. Generally, children can usually lose the weight they gain after they stop taking steroids.

Find out more about weight gain.

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Nausea and vomiting

Chemotherapy drugs can make a child feel sick, or nauseous. Some drugs may make the child throw up, or vomit. Individual drugs vary in their effects, but nausea and vomiting are more likely to occur when combinations of chemotherapy drugs are given. Some drugs don’t cause nausea until several doses have been given.

Nausea and vomiting can occur within the first few hours after chemotherapy drugs are given and usually last about 24 hours. However, delayed nausea and vomiting may last for a few days after treatment. Some children may have anticipatory nausea after having a few treatments. They feel nauseated even before treatment is given because they expect to feel sick.

Talk to the healthcare team if your child has nausea and vomiting. They can prescribe medicines to prevent or reduce these side effects.

Find out more about nausea and vomiting.

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Fatigue

Fatigue is a common side effect of chemotherapy. It causes a child to feel more tired than usual, even after sleeping and resting. Fatigue can interfere with daily activities and sleep. It may be caused by anemia, specific drugs, poor appetite or depression. It may also be related to toxic substances that are made when cancer cells break down and die.

Fatigue and weakness may be constant throughout therapy, or they may come and go. Fatigue can last for days, weeks or months. It can continue long after the child has finished cancer treatment, but it usually gets better within a few weeks of finishing treatment.

Find out more about fatigue.

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Diarrhea

Diarrhea is an increase in the number and looseness of stools. It occurs because chemotherapy drugs often affect the cells that line the digestive tract. Diarrhea can range from mild (frequent, soft stools) to severe (large amounts of liquid stool).

Many factors increase the risk of diarrhea, including the type and dose of chemotherapy drug used. It is often worse when combinations of drugs are given. Diarrhea occurs soon after chemotherapy starts and can continue for up to 2 weeks after treatment has ended.

Diarrhea during chemotherapy can also be caused by some antinausea drugs, antibiotics or intestinal infections. After chemotherapy ends and the child’s immune system returns to normal, the lining of the digestive tract heals and the diarrhea stops.

Find out more about diarrhea.

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Constipation

Constipation is having fewer than the normal number of bowel movements. The bowel movements may be hard, dry and difficult to pass. Many factors increase the risk of constipation, including the type of chemotherapy drug used and a lowered fluid intake. Medicines given with chemotherapy to relieve nausea and vomiting can also cause constipation.

Constipation usually occurs 3–7 days after the chemotherapy drug is given. It can cause pain, bloating, vomiting, bowel obstruction, hemorrhoids or fissures (tears) in the anus.

Find out more about constipation.

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Skin problems

Many children have minor skin problems while receiving chemotherapy. The most common problems are rashes, redness, itching, peeling, dry skin and acne. The child’s skin may be red, sensitive or easily irritated during and after treatment. Skin problems may occur as soon as chemotherapy is given. They can also develop days, weeks or months after chemotherapy.

Some chemotherapy drugs can make the skin more sensitive to sunlight. To protect the skin from the sun, the child should cover up and wear sunscreen while outside.

Find out more about skin problems.

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Pain at the injection site

Many chemotherapy drugs are given by an injection, often through a needle in a vein (intravenously, or IV). After the initial poke to insert the needle or catheter (tube), there is usually no discomfort or pain when IV chemotherapy drugs are given.

Sometimes drugs escape from the vein and leak into the surrounding tissues. This is called extravasation. Some chemotherapy drugs, such as vincristine (Oncovin), can be very irritating to surrounding tissues. They can cause redness, swelling, pain, burning or stinging at the injection site. In some cases, these drugs can cause severe damage to the skin and surrounding soft tissue that looks like a burn. These side effects may develop hours or days after chemotherapy is given.

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Central nervous system problems

Some chemotherapy drugs can affect the brain and spinal cord, which is called the central nervous system (CNS). The symptoms of CNS damage depend on which part of the CNS is injured. A child’s age and developmental stage can sometimes make it difficult for the healthcare team to recognize and manage these problems.

Behaviour changes

Certain chemotherapy drugs can cause thinking or behaviour changes. These changes may include:

  • mood swings
  • depression
  • fatigue
  • lack of attention
  • impulsive behaviour
  • anger
  • seizures (occasionally)

Behaviour changes from chemotherapy should go away once treatment is finished.

Peripheral neuropathy

Certain types of chemotherapy, such as vincristine (Oncovin), can cause peripheral neuropathy. Peripheral neuropathy is the loss of movement or sensation in one or more nerves. It can occur days to weeks after chemotherapy. The symptoms may come and go and may last for many months after chemotherapy is finished.

Signs and symptoms of peripheral neuropathy may include:

  • frequent falls
  • clumsiness
  • stumbling
  • inability to hold things, open bottles or undo buttons
  • difficulty climbing or playing with toys, especially small toys
  • tingling, numbness and feeling of pin pricks in the fingers or toes

Find out more about nervous system damage and chemotherapy.

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Allergic reactions

Allergic reactions are not a common side effect of chemotherapy, but they can happen. Allergic reactions are most likely to occur when drugs are given by a needle into a vein (intravenously). They may happen immediately or several hours after the drugs are given, and they can be mild or serious. Although any drug can cause an allergic reaction, some chemotherapy drugs are more likely than others to cause allergic reactions.

Children are closely monitored for allergic reactions during chemotherapy, especially when they first start treatment. An allergic reaction may include:

  • a rash, such as hives
  • itching
  • difficulty breathing
  • swelling in part of the body
  • fever and chills

Find out more about allergic reactions to chemotherapy.

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Reproduction and sexuality problems

Chemotherapy can affect the reproductive system. It can lower the hormones made by the ovaries or testicles. This can lead to delayed puberty. As a side effect of certain chemotherapy drugs, some children may not be able to have children (may be infertile) when they are adults.

Find out more about female reproductive system problems and male reproductive system problems.

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

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