Chemotherapy for Childhood Non-Hodgkin Lymphoma
- Children with non-Hodgkin lymphoma often receive chemotherapy as a treatment
- The drugs used may be the same as those used in adults, but the combinations may be different
- Children may be treated more aggressively than adults because they can tolerate side effects better
"The chemotherapy that we give pediatric patients for non-Hodgkin lymphoma usually involves a number of chemotherapy agents. They're very similar to the regimens that are used in adults, but have slightly different combinations," explains Dr. Matthew Barth, pediatric oncologist at Roswell Park Comprehensive Cancer Center.
Types of Chemotherapy Drugs
Read More- cyclophosphamide
- vincristine
- prednisone
- methotrexate
- cytarabine
- etoposide
How Kids Get Chemotherapy
Depending on the type of lymphoma and the specific drug being used, the chemotherapy may be given by mouth or injected into a vein or muscle. In these cases the therapy is called systemic chemotherapy, and it allows the drugs to enter the bloodstream and reach cancer cells throughout the body.Chemotherapy drugs can also be targeted to a specific organ or body cavity (such as the abdomen). Or they can be placed directly into the cerebrospinal fluid (called intrathecal chemotherapy), often to lessen the chance of cancer spreading to the brain.
Side Effects
"Most of the drugs that we use are traditional chemotherapy agents, which will kill faster-dividing cells," explains Dr. Barth. "Because lymphoma cells are very metabolically active, they grow very quickly and require a lot of nutrients to grow. They are potentially susceptible to damage because they grow so quickly. So a lot of these chemotherapy drugs work in a way that damages cells as they grow quickly. And that's part of the reason why we get some of the side effects that we do, because then other tissues that are constantly regenerating will also be affected by those chemotherapies."
Children tend to be treated very aggressively with chemotherapy, but they usually tolerate the drugs better than adults do. "They do have a lot of side effects, but they recover from them well," says Dr. Barth.
The biggest side effects that doctors worry about in children are low levels of normal blood cells. While the chemotherapy is designed to kill the blood cells involved with lymphoma, they affect normal blood cells as well. That means patients often require transfusions of red blood cells or platelets, and they'll frequently have low levels of white blood cells. "And when that happens, they're at high risk for infection," says Dr. Barth.
Like adults, children undergoing chemotherapy may experience painful mouth sores. "The cells that line your oral mucosa are constantly being regenerated, so they can also be affected," explains Dr. Barth. "Sores can develop in the mouth all the way through the gastrointestinal tract and can cause a lot of pain and disrupt the ability to eat and drink."
Side effects are different with the monoclonal antibody, rituximab (Rituxan). This drug specifically targets the B-cells that are often involved in childhood non-Hodgkin lymphoma. "It will kill the lymphoma cells and then also the normal B cells," explains Dr. Barth. "So whereas the rituximab doesn't tend to have as many systemic [body-wide] side effects, it can cause patients to have a low number of B cells for a prolonged period of time that can sometimes put them at risk for some types of infections."
Pediatric oncologists will work with their young patients to reduce the risk of infection and help treat mouth sores so children can eat comfortably. While chemotherapy treatment may be unpleasant in the short term, the high success rate in curing childhood non-Hodgkin lymphoma makes the temporary side effects well worth the discomfort.
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