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Home > Living Well > Health Library > Childhood Non-Hodgkin Lymphoma Treatment (PDQ®): Treatment - Patient Information [NCI]
This information is produced and provided by the National Cancer Institute (NCI). The information in this topic may have changed since it was written. For the most current information, contact the National Cancer Institute via the Internet web site at http://cancer.gov or call 1-800-4-CANCER.
Childhood non-Hodgkin lymphoma is a disease in which malignant (cancer) cells form in the lymph system, which is a part of the body's immune system.
The immune system helps protect the body from infection and disease.
The lymph system is made up of the following:
Anatomy of the lymph system, showing the lymph vessels and lymph organs including lymph nodes, tonsils, thymus, spleen, and bone marrow. Lymph (clear fluid) and lymphocytes travel through the lymph vessels and into the lymph nodes where the lymphocytes destroy harmful substances. The lymph enters the blood through a large vein near the heart.
Lymph tissue is also found in other parts of the body such as the stomach, thyroid gland, brain, and skin.
Non-Hodgkin lymphoma can begin in B lymphocytes, T lymphocytes, or natural killer cells.
There are two general types of lymphomas: Hodgkin lymphoma and non-Hodgkin lymphoma. This summary is about the treatment of childhood non-Hodgkin lymphoma. For information about the treatment of childhood Hodgkin lymphoma, see Childhood Hodgkin Lymphoma Treatment.
Treatment of non-Hodgkin lymphoma is different for children and adults. For information about treatment of adults, see the following:
There are three major types of childhood non-Hodgkin lymphoma.
The type of lymphoma is determined by how the cells look under a microscope. The three major types of childhood non-Hodgkin lymphoma are:
Aggressive mature B-cell non-Hodgkin lymphoma
Aggressive mature B-cell non-Hodgkin lymphomas include:
Both Burkitt leukemia and Burkitt lymphoma have been linked to infection with the Epstein-Barr virus (EBV), although EBV infection is more likely to occur in patients in Africa than in the United States. Burkitt lymphoma/leukemia is more common in White people. Burkitt lymphoma/leukemia is diagnosed when a sample of tissue is checked and a certain change to the MYCgene is found.
Lymphoblastic lymphoma is a type of lymphoma that mainly affects T-cell lymphocytes. It usually forms in the mediastinum (the area between the lungs). This causes trouble breathing, wheezing, trouble swallowing, or swelling of the head and neck. It may spread to lymph nodes, bone, bone marrow, skin, the CNS, abdominal organs, and other areas. Lymphoblastic lymphoma is a lot like acute lymphoblastic leukemia (ALL).
Anaplastic large cell lymphoma
Anaplastic large cell lymphoma is a type of lymphoma that mainly affects T-cell lymphocytes. It usually forms in the lymph nodes, skin, or bone, and sometimes forms in the gastrointestinal tract, lung, tissue that covers the lungs, and muscle. Patients with anaplastic large cell lymphoma have a receptor, called CD30, on the surface of their T cells. In many children, anaplastic large cell lymphoma is marked by changes in the ALK gene that makes a protein called anaplastic lymphoma kinase. A pathologist checks for these cell and gene changes to help diagnose anaplastic large cell lymphoma.
Some types of non-Hodgkin lymphoma are rare in children.
Some types of childhood non-Hodgkin lymphoma are less common. These include:
Having a weakened immune system increases the risk of NHL in children.
Anything that increases a person's risk of getting a disease is called a risk factor. Not every child with one or more of these risk factors will develop NHL, and it will develop in some children who don't have any known risk factors. Talk with your child's doctor if you think your child may be at risk.
Some of the types of immune system problems that have been linked with a higher risk of childhood NHL include the following:
If lymphoma or lymphoproliferative disease is linked to a weakened immune system from certain inherited diseases, HIV infection, a transplant or medicines given after a transplant, the condition is called lymphoproliferative disease associated with immunodeficiency. The different types of lymphoproliferative disease associated with immunodeficiency include:
Signs of childhood non-Hodgkin lymphoma include breathing problems and swollen lymph nodes.
These and other signs may be caused by childhood non-Hodgkin lymphoma or by other conditions. Check with a doctor if your child has any of the following:
Tests that examine the body and lymph system are used to diagnose childhood non-Hodgkin lymphoma.
The following tests and procedures may be used:
A biopsy is done to diagnose childhood non-Hodgkin lymphoma.
Cells and tissues are removed during a biopsy so they can be viewed under a microscope by a pathologist to check for cancer cells. Because treatment depends on the type of non-Hodgkin lymphoma, biopsy samples should be checked by a pathologist who has experience in diagnosing childhood non-Hodgkin lymphoma.
One of the following types of biopsies may be done:
The procedure used to remove the sample of tissue depends on where the tumor is in the body:
If cancer is found, the following tests may be done to study the cancer cells:
Certain factors affect prognosis (chance of recovery) and treatment options.
The prognosis and treatment options depend on:
After childhood non-Hodgkin lymphoma has been diagnosed, tests are done to find out if cancer cells have spread within the lymph system or to other parts of the body.
The process used to find out if cancer has spread within the lymph system or to other parts of the body is called staging. The results of tests and procedures used to diagnose non-Hodgkin lymphoma may also be used for staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment.
For a description of the tests and procedures used to diagnose non-Hodgkin lymphoma, see General Information.
There are three ways that cancer spreads in the body.
Cancer can spread through tissue, the lymph system, and the blood:
The following stages are used for childhood non-Hodgkin lymphoma:
Stage I childhood non-Hodgkin lymphoma. Cancer is found in one group of lymph nodes or one area outside the lymph nodes, but no cancer is found in the abdomen or mediastinum (area between the lungs).
In stage I childhood non-Hodgkin lymphoma, cancer is found:
No cancer is found in the abdomen or mediastinum (area between the lungs).
Stage II childhood non-Hodgkin lymphoma. Cancer is found in one area outside the lymph nodes and in nearby lymph nodes (a); or in two or more areas above (b) or below (c) the diaphragm; or cancer started in the stomach, appendix, or intestines (d) and can be removed by surgery.
In stage II childhood non-Hodgkin lymphoma, cancer is found:
Stage III childhood non-Hodgkin lymphoma. Cancer is found in at least one area above and below the diaphragm (a); or cancer started in the chest (b); or cancer started in the abdomen and spread throughout the abdomen (c); or in the area around the spine (not shown).
In stage III childhood non-Hodgkin lymphoma, cancer is found:
Stage IV childhood non-Hodgkin lymphoma. Cancer is found in the bone marrow, brain, or cerebrospinal fluid (CSF). Cancer may also be found in other parts of the body.
In stage IV childhood non-Hodgkin lymphoma, cancer is found in the bone marrow, brain, or cerebrospinal fluid. Cancer may also be found in other parts of the body.
Sometimes childhood non-Hodgkin lymphoma does not respond to treatment or recurs (comes back) after treatment.
Refractory non-Hodgkin lymphoma is cancer that does not respond to initial treatment.
Recurrent non-Hodgkin lymphoma is cancer that has come back after treatment. It may come back in the lymph system or in other parts of the body.
There are different types of treatment for children with non-Hodgkin lymphoma.
Different types of treatment are available for children with non-Hodgkin lymphoma. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.
Taking part in a clinical trial should be considered for all children with non-Hodgkin lymphoma. Some clinical trials are open only to patients who have not started treatment.
Children with non-Hodgkin lymphoma should have their treatment planned by a team of doctors who are experts in treating childhood cancer.
Treatment will be overseen by a pediatric oncologist, a doctor who specializes in treating children with cancer. The pediatric oncologist works with other health care providers who are experts in treating children with non-Hodgkin lymphoma and who specialize in certain areas of medicine. These may include the following specialists:
Eight types of standard treatment are used:
Surgery may be done to remove as much of the tumor as possible for some types of childhood non-Hodgkin lymphoma. After the doctor removes all the cancer that can be seen at the time of surgery, patients may be given chemotherapy to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid (intrathecal chemotherapy), an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas. Combination chemotherapy is treatment using two or more anticancer drugs.
Intrathecal chemotherapy may be used to treat childhood non-Hodgkin lymphoma that has spread, or may spread, to the brain. When used to lessen the chance cancer will spread to the brain, it is called CNS prophylaxis. Intrathecal chemotherapy is given in addition to chemotherapy by mouth or vein. Higher than usual doses of chemotherapy may also be used as CNS prophylaxis.
Intrathecal chemotherapy. Anticancer drugs are injected into the intrathecal space, which is the space that holds the cerebrospinal fluid (CSF, shown in blue). There are two different ways to do this. One way, shown in the top part of the figure, is to inject the drugs into an Ommaya reservoir (a dome-shaped container that is placed under the scalp during surgery; it holds the drugs as they flow through a small tube into the brain). The other way, shown in the bottom part of the figure, is to inject the drugs directly into the CSF in the lower part of the spinal column, after a small area on the lower back is numbed.
The way the chemotherapy is given depends on the type and stage of the cancer being treated.
For more information, see Drugs Approved for Non-Hodgkin Lymphoma.
Radiation therapy is a cancer treatment that uses high energy x-rays or other types of radiation to kill cancer cells or keep them from growing. External radiation therapy uses a machine outside the body to send radiation toward the area of the body with cancer. External radiation therapy may be used to treat childhood non-Hodgkin lymphoma that has spread, or may spread, to the brain and spinal cord. External radiation therapy may also be used to treat cutaneous T-cell lymphoma (mycosis fungoides).
High-dose chemotherapy with stem cell transplant
High doses of chemotherapy are given to kill cancer cells. Healthy cells, including blood -forming cells, are also destroyed by the cancer treatment. Stem cell transplant is a treatment to replace the blood-forming cells. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient or a donor and are frozen and stored. After the patient completes chemotherapy, the stored stem cells are thawed and given to the patient through an infusion. These reinfused stem cells grow into (and restore) the body's blood cells.
Stem cell transplant. (Step 1): Blood is taken from a vein in the arm of the donor. The patient or another person may be the donor. The blood flows through a machine that removes the stem cells. Then the blood is returned to the donor through a vein in the other arm. (Step 2): The patient receives chemotherapy to kill blood-forming cells. The patient may receive radiation therapy (not shown). (Step 3): The patient receives stem cells through a catheter placed into a blood vessel in the chest.
Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells. Targeted therapies usually cause less harm to normal cells than chemotherapy or radiation therapy do. Types of targeted therapy include the following:
Types of monoclonal antibodies include:
Other targeted therapies are being studied for the treatment of childhood non-Hodgkin lymphoma that has not responded to treatment or has recurred (come back).
Other drug therapy
Retinoids are drugs related to vitamin A. Retinoid therapy with bexarotene is used to treat several types of cutaneous T-cell lymphoma.
Steroids are hormones made naturally in the body. They can also be made in a laboratory and used as drugs. Steroid therapy that is applied to the skin is used to treat cutaneous T-cell lymphoma. Dexamethasone and prednisone are steroids used with other drugs to treat certain types of lymphoma.
Antibiotics are drugs used to treat infections and cancer caused by bacteria or other microorganisms. Antibiotics have been used to treat mucosa-associated lymphoid tissue (MALT) lymphoma. Treatment with antibiotic therapy has been mostly studied in adults.
Phototherapy is a cancer treatment that uses a drug and a certain type of laser light to kill cancer cells. A drug that is not active until it is exposed to light is injected into a vein. The drug collects more in cancer cells than in normal cells. For skin cancer in the skin, laser light is shined onto the skin and the drug becomes active and kills the cancer cells. Phototherapy is used in the treatment of cutaneous T-cell lymphoma.
Watchful waiting is closely monitoring a patient's condition without giving any treatment until signs or symptoms appear or change.
New types of treatment are being tested in clinical trials.
This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI website.
Immunotherapy is a treatment that uses the patient's immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer. This cancer treatment is a type of biological therapy.
Treatment for childhood non-Hodgkin lymphoma may cause side effects.
For information about side effects that begin during treatment for cancer, see our Side Effects page.
Side effects from cancer treatment that begin after treatment and continue for months or years are called late effects. Late effects of cancer treatment may include the following:
Some late effects may be treated or controlled. It is important to talk with your child's doctors about the effects cancer treatment can have on your child. For more information, see Late Effects of Treatment for Childhood Cancer.
Patients may want to think about taking part in a clinical trial.
For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.
Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
Patients can enter clinical trials before, during, or after starting their cancer treatment.
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.
Clinical trials are taking place in many parts of the country. Information about clinical trials supported by NCI can be found on NCI's clinical trials search webpage. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.
Follow-up tests may be needed.
Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.
Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your child's condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.
Treatment of Burkitt lymphoma/leukemia
For information about the treatments listed below, see Treatment Option Overview.
Treatment of newly diagnosed Burkitt lymphoma /leukemia may include:
Treatment of recurrent or refractory Burkitt lymphoma/leukemia
Treatment of recurrent or refractory Burkitt lymphoma /leukemia may include:
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.
Diffuse large B-cell lymphoma
Treatment of diffuse large B-cell lymphoma
Treatment of newly diagnosed diffuse large B-cell lymphoma may include:
Treatment of recurrent or refractory diffuse large B-cell lymphoma
Treatment of recurrent or refractory diffuse large B-cell lymphoma may include:
Primary Mediastinal B-cell Lymphoma
Treatment of primary mediastinal B-cell lymphoma
Treatment of newly diagnosed primary mediastinal B-cell lymphoma may include:
Treatment of recurrent or refractory primary mediastinal B-cell lymphoma
Treatment of recurrent or refractory primary mediastinal B-cell lymphoma may include:
Treatment of lymphoblastic lymphoma
Lymphoblastic lymphoma may be classified as the same disease as acute lymphoblastic leukemia (ALL). Treatment of lymphoblastic lymphoma may include:
Treatment of recurrent or refractory lymphoblastic lymphoma
Treatment of recurrent or refractory lymphoblastic lymphoma may include:
Anaplastic Large Cell Lymphoma
Treatment of anaplastic large cell lymphoma
Treatment of anaplastic large cell lymphoma may include:
Treatment of recurrent or refractory anaplastic large cell lymphoma
Treatment of recurrent or refractory anaplastic large cell lymphoma may include:
Lymphoproliferative Disease Associated With Immunodeficiency in Children
Treatment of lymphoproliferative disease associated with primary immunodeficiency
Treatment of lymphoproliferative disease in children and adolescents with weakened immune systems may include:
Treatment of non-Hodgkin lymphoma associated with DNA repair defect syndromes
Treatment of non-Hodgkin lymphoma associated with DNA repair defect syndromes in children may include:
Treatment of HIV-associated non-Hodgkin lymphoma
Treatment with highly active antiretroviral therapy or HAART (a combination of antiretroviral drugs) lowers the risk of non-Hodgkin lymphoma in patients infected with the human immunodeficiency virus (HIV).
Treatment of HIV-related non-Hodgkin lymphoma (NHL) in children may include:
For treatment of recurrent disease, treatment options depend on the type of non-Hodgkin lymphoma.
Treatment of post-transplant lymphoproliferative disease
Treatment of post-transplant lymphoproliferative disease may include:
Rare NHL Occurring in Children
Treatment of pediatric-type follicular lymphoma
Treatment of follicular lymphoma in children may include:
For children whose cancer has certain changes in the genes, treatment is similar to that given to adults with follicular lymphoma. For information about the treatment of follicular lymphoma in adults, see Adult Non-Hodgkin Lymphoma.
Treatment of marginal zone lymphoma
Treatment of marginal zone lymphoma (including mucosa-associated lymphoid tissue [MALT] lymphoma) in children may include:
Treatment of primary CNS lymphoma
Treatment of primary CNS lymphoma in children may include:
Treatment of peripheral T-cell lymphoma
Treatment of peripheral T-cell lymphoma in children may include:
Treatment of cutaneous T-cell lymphoma
Treatment of subcutaneous panniculitis-like cutaneous T-cell lymphoma in children may include:
Treatment of cutaneous anaplastic large cell lymphoma may include:
In children, treatment of mycosis fungoides may include:
For more information from the National Cancer Institute about childhood non-Hodgkin lymphoma, see the following:
For more childhood cancer information and other general cancer resources, see the following:
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Purpose of This Summary
This PDQ cancer information summary has current information about the treatment of childhood non-Hodgkin lymphoma. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.
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Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Updated") is the date of the most recent change.
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Clinical Trial Information
A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
Clinical trials can be found online at NCI's website. For more information, call the Cancer Information Service (CIS), NCI's contact center, at 1-800-4-CANCER (1-800-422-6237).
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The best way to cite this PDQ summary is:
PDQ® Pediatric Treatment Editorial Board. PDQ Childhood Non-Hodgkin Lymphoma Treatment. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: https://www.cancer.gov/types/lymphoma/patient/child-nhl-treatment-pdq. Accessed <MM/DD/YYYY>. [PMID: 26389294]
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Last Revised: 2022-06-28
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