Treatments for childhood classical Hodgkin lymphoma

If your child has classical Hodgkin lymphoma (HL), the healthcare team will create a treatment plan just for your child. It will be based on your child’s health and specific information about the HL. When deciding which treatments to offer for childhood classical HL, the healthcare team will consider the stage, risk group and response to treatment.

Children in the low-risk group need less intense treatment because the cancer is more likely to respond to treatment and less likely to come back (recur). Children in the high-risk group need more intense treatment because the cancer is more aggressive and more likely to recur.

Children who have an early response to treatment may not need as much or as intense treatment as children who do not have an early response.

Children with classical HL are usually treated with chemotherapy. Different types of chemotherapy drugs are used based on the risk group of the cancer. They may also be offered radiation therapy after chemotherapy.

Low-risk childhood classical HL is stage 1 or 2 disease with no bulky tumours (a large tumour in a lymph node or group of lymph nodes) and no B symptoms (fever, night sweats and weight loss). Treatment options for low-risk childhood classical HL include the following.

Chemotherapy is the primary treatment for low-risk childhood classical HL. Chemotherapy combinations used include:

• VAMP – vincristine (Oncovin), doxorubicin (Adriamycin), methotrexate and prednisone
• COPP/ABV – cyclophosphamide (Procytox), vincristine, prednisone, procarbazine hydrochloride (Matulane) with doxorubicin, bleomycin (Blenoxane) and vinblastine
• OEPA – vincristine, etoposide (Vepesid, VP-16), prednisone and doxorubicin
• ABVD – doxorubicin, bleomycin, vinblastine and dacarbazine
• DBVE – doxorubicin, bleomycin, vincristine and etoposide
• AV-PC – doxorubicin, vincristine, prednisone, cyclophosphamide

Find out more about chemotherapy for childhood Hodgkin lymphoma.

After chemotherapy, low-dose radiation therapy may be given to the areas that have cancer. The type of radiation therapy used is external beam radiation therapy. During external beam radiation therapy, a machine directs radiation through the skin to the tumour and some of the tissue around it. The dose of radiation and the area treated are kept as small as possible.

Find out more about radiation therapy for childhood Hodgkin lymphoma.

Intermediate-risk childhood classical HL can be stage 1, 2 or 3. Childhood classical HL is intermediate-risk if it is:

• stage 1 or 2 disease with bulky tumour or B symptoms (fever, night sweats and weight loss)
• stage 3 disease with no B symptoms

Treatment options for intermediate-risk childhood classical HL include the following.

Chemotherapy is the primary treatment for intermediate-risk childhood classical HL. Chemotherapy combinations used include:

• COPP/ABV – cyclophosphamide (Procytox), vincristine (Oncovin), prednisone, procarbazine hydrochloride (Matulane) with doxorubicin (Adriamycin), bleomycin (Blenoxane) and vinblastine
• OEPA plus COPDAC – vincristine, etoposide (Vepesid, VP-16), prednisone and doxorubicin with cyclophosphamide, vincristine, prednisone and dacarbazine
• ABVE-PC – doxorubicin, bleomycin, vincristine and etoposide with prednisone and cyclophosphamide
• ABVE-PC plus DECA - doxorubicin, bleomycin, vincristine, etoposide, prednisone and cyclophosphamide with dexamethasone, etoposide, cisplatin and cytarabine (Cytosar)

Find out more about chemotherapy for childhood Hodgkin lymphoma.

After chemotherapy, low-dose radiation therapy may be given to the areas that have cancer. The type of radiation therapy used is external beam radiation therapy. During external beam radiation therapy, a machine directs radiation through the skin to the tumour and some of the tissue around it. The dose of radiation and the area treated are kept as small as possible.

Find out more about radiation therapy for childhood Hodgkin lymphoma.

High-risk childhood classical HL is stage 2 disease with B symptoms (fever, night sweats and weight loss) and bulky disease, stage 3 disease with B symptoms or stage 4 disease. Treatment options for high-risk classical HL include the following.

Chemotherapy is the primary treatment for high-risk childhood classical HL. Chemotherapy is given in higher doses to treat high-risk classical HL. Chemotherapy combinations used include:

• OEPA plus COPDAC – vincristine (Oncovin), etoposide (Vepesid, VP-16), prednisone and doxorubicin (Adriamycin) with cyclophosphamide (Procytox), vincristine, prednisone and dacarbazine
• ABVE-PC – doxorubicin, bleomycin (Blenoxane), vincristine and etoposide with prednisone and cyclophosphamide
• BEACOPP followed by COPP/ABV (given to girls) – bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, prednisone and procarbazine hydrochloride followed by cyclophosphamide, vincristine, prednisone and procarbazine hydrochloride with doxorubicin, bleomycin and vinblastine
• BEACOPP followed with ABVD (given to boys) – bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, prednisone and procarbazine hydrochloride followed by doxorubicin, bleomycin, vinblastine and dacarbazine
• BEACOPP – bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, prednisone and procarbazine hydrochloride

Find out more about chemotherapy for childhood Hodgkin lymphoma.

After chemotherapy, low-dose radiation therapy may be given to the areas that have cancer. The type of radiation therapy used is external radiation therapy. During external radiation therapy, a machine directs radiation through the skin to the tumour and some of the tissue around it. The dose of radiation and the area treated are kept as small as possible.

Find out more about radiation therapy for childhood Hodgkin lymphoma.

Follow-up after treatment is an important part of cancer care. Your child will need to have regular follow-up visits, especially in the first 10 years after treatment has finished. These visits allow the healthcare team to monitor your child’s progress and recovery from treatment. They will also watch for late side effects from treatment. Find out more about follow-up care.

Children with cancer may be treated in a clinical trial. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.