Treating Hodgkin Lymphoma in Children

If a child is past puberty and muscles and bones are fully developed, treatment is usually the same as that given to adults. But if the child has not reached his or her full body size, chemotherapy (chemo) will likely be favored over radiation therapy. This is because radiation can affect bone and muscle growth and keep children from reaching their normal size.

Children’s bodies tend to tolerate chemotherapy better in the short term than adults do. But some side effects are more likely to occur in children. Because some of these side effects could be long-term or might not occur until years later, children who survive cancer need careful attention for the rest of their lives.

Since the 1960s, most children and teens with cancer have been treated at special centers designed for them. Being treated in these centers offers the advantage of having a team of specialists who are experienced with the differences between adult and childhood cancers, as well as the unique needs of children with cancer and their families. This team usually includes pediatric oncologists, surgeons, radiation oncologists, pathologists, pediatric oncology nurses, and nurse practitioners.

Childhood cancer centers also have psychologists, social workers, child life specialists, nutritionists, rehabilitation and physical therapists, and educators who can support the entire family.

Most children with cancer in the United States are treated at a center that's a member of the Children’s Oncology Group (COG). All of these centers are associated with a university or children’s hospital. As we have learned more about treating childhood cancer, it has become even more important that treatment be given by experts in this area.

In these centers, doctors treating children with HL often use treatment plans that are part of clinical trials. The purpose of these studies is to find the best treatments that cause the fewest side effects.

Any time a child or teen is diagnosed with cancer, it affects every family member and nearly every aspect of the family’s life. You can read more about coping with these changes in If Your Child Is Diagnosed with Cancer. 

Treating classic Hodgkin lymphoma (cHL) in children

For children with classic Hodgkin lymphoma (cHL), chemotherapy (chemo) is typically the main treatment. Low doses of radiation might be part of the treatment as well, although doctors try to avoid giving it to children when possible.

The chemo regimens used for children often include combinations of more drugs than are used in adults, especially for lymphomas that have unfavorable features or are more advanced. In some situations, another type of drug such as brentuximab vedotin (Adcetris) or nivolumab (Opdivo) might be included as part of the regimen as well.

This approach has had excellent success rates, even for children with more advanced disease.

Stages IA and IIA, favorable

Treatment generally starts with chemo alone, used at the lowest dose that's likely to result in a cure. PET scans may be used to see if the treatment is working and/or if there's any lymphoma left in the body. If the HL doesn’t go away completely, radiation therapy or more chemo might be needed.

Studies have suggested that HL in children can be cured without using radiation. This avoids the long-term problems it can cause. But, if radiation therapy is used, the dose and area treated are kept as small as possible. If radiation is used on the lower part of the body in girls and young women, the ovaries should be protected to help preserve fertility.

Stages I and II, unfavorable

Treatment is likely to consist of a more intense chemo regimen, which might include brentuximab vedotin in some cases. Radiation therapy will likely be given as well, but the dose and field of radiation will be kept as small as possible.

Stages III and IV

Treatment for these more advanced lymphomas typically begins with more intense chemo, which might include another type of drug such as brentuximab vedotin or nivolumab. Radiation therapy might be given to areas with bulky disease (areas that contain a lot of lymphoma).

Relapsed or refractory cHL

If the lymphoma comes back or is no longer responding to treatment, different types of chemo regimens might be tried. Other options might include a stem cell transplant or treatment with an immunotherapy drug (sometimes along with chemo).

Treating nodular lymphocyte-predominant Hodgkin lymphoma in children

Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is very rare in children. There's no single best treatment, and treatments used are often much like those used to treat cHL and/or those used to treat adult NLPHL.

There is one exception: In the early stages of NLPHL in children, surgery to remove the affected lymph node may be the only treatment needed. After surgery, these children are watched closely for signs of lymphoma. Chemo can be used if it comes back.