Treatments for primary progressive or recurrent childhood HL
The following are treatment options for primary progressive (also called resistant) or recurrent childhood Hodgkin lymphoma (HL). Primary progressive childhood HL is lymphoma that continues to grow or spread during treatment. Recurrent childhood HL means that the cancer has come back after it has been treated. It may recur in the same place as the original cancer, or it may recur in another part of the body.
Treatment of primary progressive or recurrent childhood HL may involve:
- chemotherapy with low-dose radiation therapy to areas that have cancer
- high-dose chemotherapy followed by stem cell transplant, with or without radiation therapy
Treatment for recurrent HL depends on where the cancer recurs, past treatments and the time since the first treatment was completed.
Chemotherapy is the primary treatment for primary progressive or recurrent childhood HL.
Chemotherapy drugs and drug combinations used include:
- ICE – ifosfamide (Ifex), carboplatin (Paraplatin, Paraplatin AQ) and etoposide (Vepesid, VP-16)
- ifosfamide and vinorelbine (Navelbine)
- vinorelbine and gemcitabine (Gemzar)
- ifosfamide, etoposide and prednisone
- doxorubicin (Adriamycin), bleomycin (Blenoxane), vinblastine (Velbe) and dacarbazine (DTIC)
- cyclophosphamide (Cytoxan, Procytox), vincristine (Oncovin), procarbazine hydrochloride (Matulane) and prednisone
- APE – cytarabine (Cytosar, Ara-C), cisplatin (Platinol AQ) and etoposide
- MIED – high-dose methotrexate, ifosfamide, etoposide and dexamethasone (Decadron, Dexasone)
- rituximab (Rituxan)
- DHAP – dexamethasone, cisplatin and cytarabine
- ESHPA – etoposide, methylprednisone (Medrol), cytarabine and cisplatin
High-dose chemotherapy can also be used, followed by stem cell transplant. Chemotherapy regimens used for stem cell transplant are:
- BEAM – carmustine (BiCNU, BCNU), etoposide, cytarabine and melphalan (Alkeran, L-PAM)
- CBV – cyclophosphamide, carmustine and etoposide
- thiotepa (ThioTEPA), etoposide with cyclophosphamide and carboplatin or melphalan
- high-dose busulfan (Myleran [oral], Busulfex [intravenous]), etoposide and cyclophosphamide
Low-dose radiation therapy may be given to areas that have cancer if they were not already treated with radiation therapy.
Radiation therapy may also be used, along with chemotherapy, before stem cell transplant.
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.
Stem cell transplant
Stem cell transplant may be used to treat primary progressive childhood HL if the disease continues to grow after both chemotherapy and radiation therapy.
It may also be used for recurrent HL if the disease comes back very soon after treatment with chemotherapy and radiation therapy.
Many children with Hodgkin lymphoma enter a clinical trial that is tailored to the risk group or stage of their disease. The clinical trial protocol outlines the chemotherapy drugs and doses used. Find out more about clinical trials.
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