Treating classic Hodgkin lymphoma in children – a guideline

These guidelines reviewed current recommendations on treating newly diagnosed classic Hodgkin lymphoma (cHL) in children and young adults, and cHL which has returned after previous treatment.

Hodgkin lymphoma is cancer of the lymph nodes, which are part of the immune system. It involves cancerous versions of B cells, which are a type of white blood cell. Most cases of HL occur during childhood. In children and young adults, 90 to 95% of cases are of the most common type, cHL. These guidelines cover the treatment of cHL in children.

These recommendations were developed primarily using research trials and reviews of current research. They also use doctors’ clinical experience in treating patients with cHL.

A history of symptoms, physical examination, and blood tests are needed when a child is diagnosed with cHL. Typical symptoms include fevers, night sweats, and weight loss. A positive emission tomography (PET) scan is used to visualize which areas of the body the cancer has spread to.

The guidelines recommend enrolling in a clinical trial if one is available. Patients in clinical trials receive the most current treatment options and are followed closely, and also contribute to improving cancer treatment in the future.

Treatment for CHL generally begins with chemotherapy. After one or several cycles of chemotherapy, a PET scan is used to evaluate how the cancer has responded. Radiation treatment is recommended if there are still signs of cancer. Current imaging methods have improved the ability to direct radiation only to areas with cancer, while avoiding the internal organs.

The specific chemotherapy regimen used depends on the type and stage of the cancer. CHL which has not spread from the first group of lymph nodes and does not have large areas of cancer is generally low risk. The recommended chemotherapy for these patients is OEPA (vincristine, etoposide, prednisone, doxorubicin). Intermediate risk cHL includes patients with at least one large (bulky) area of cancer. The recommended chemotherapy regimen for this group is ABVE-PE (doxorubicin, bleomycin, vincristine, etoposide, cyclophosphamide, prednisone). ABVE-PE is also used for high-risk cHL, which includes cancer spread to both the upper and lower haves of the body. Other chemotherapy regimens are also used for cHL, including ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine).

After treatment is complete, it is not recommended to use routine PET scans unless there are signs or symptoms of cHL. This is because PET scans may suggest the cancer has returned when it has not, leading to unnecessary treatment. However, computerized tomography (CT) scans can be used for follow-up for two years after treatment.

CHL has very good treatment outcomes. However, the cancer will relapse (return) for around 10% of patients with early-stage cHL, and 25% of patients with advanced disease. For patients whose cancer relapses, there are several options. Stronger chemotherapy regimens can be used. A stem cell transplant involves isolating stem cells from the blood or bone marrow. After chemotherapy to kill off the cancer, the stem cells are used to replace the body’s white blood cells. Alternately, antibody treatments including brentuximab vedotin (Adcetris) target cancer cells specifically.

There can be long-term side effects from chemotherapy and radiation treatment. It is recommended to speak to a fertility preservation specialist before starting treatment. Also, depending on the type of chemotherapy being considered, the heart or lungs may need to be tested before and/or after treatment.

These guidelines reviewed current recommendations on treating newly diagnosed cHL in children and young adults, and cHL which has returned after previous treatment.

These are general guidelines. Your doctor will tailor these guidelines to your specific medical history.