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Treatment of lymphoma

Hodgkin's lymphoma

In Norway in the last 10 years, children and youth up to 18 years have been treated from protocols developed by Gesellschaft für Pädiatrische Hematologie und Onkologie from Germany and Austria. In consecutive studies, this group has since 1978, gradually changed the chemotherapy and reduced the use of radiation treatment while simultaneously maintaining good survival rates. The most recent protocol GPOH-HD-95 in its latest version is considered standard treatment for Hodgkin's lymphoma in children up to 18 years.

The treatment for most patients includes both chemotherapy and radiation. The initial diagnostics which determines the extensiveness of the tumor is crucial for irradiation of the original tumor volume. Planning of radiation therapy and necessary preliminary testing in advance is important to avoid delays in therapy. A close collaboration between the oncologist, pediatrician, and radiation therapist is therefore essential from the start.

In overview, two courses of OPPA are given to girls and 2 courses of OEPA to boys, regardless of therapy group. In therapy group 1, no further chemotherapy is given (1). Patients with complete radiological remission are not treated with radiation. Those with remaining tumor will be irradiated to the original tumor area with 20–35 Gy depending on the size of the remaining tumor. In therapy group 2 and 3, either 2 or 4 COPP courses are given respectively after OPPA or OEPA. All patients in therapy group 2 and 3 on this protocol should have radiation treatment, mainly to the original tumor volume with a minimum of 20 Gy. The comprehensiveness of radiation therapy is specified more closely in the protocols, which are available at oncology and radiation therapy divisions at the regional hospitals.

Since 2008, Norway has participated in a European study for treatment of Hodgkin's lymphoma in children and youth up to 18 years (the EuroNet-PHL-C1 study).

Non-Hodgkin lymphoma

There have been great advancements in the treatment of non-Hodgkin lymphoma in the last decade. The reason for this is the use of intensive combination treatments in primary treatment. Before 1970, the prognosis for non-Hodgkins lymphoma was poor. Only a minority survived 5 years after the diagnosis, and most of these had localized disease. Surgery and radiation therapy were effective in patients having stage I and II non-Hodgkins lymphoma, but 2/3 of patients experienced recurrence.

Today, chemotherapy is the primary treatment for all histologies and stages of childhood non-Hodgkins lymphoma (9). 

The patients are categorized into 3 main therapy groups with subgroups.

Subgroups of non-Hodgkin's lymphoma
Therapy group I  (Non B cell)  Therapy group II  (B cell) Therapy group III  (LCAL)
  • Lymphoblastic lymphoma
  • Pre B cell
  • T cell
  • Peripheral T cell lymphoma
  • Other pleomorphic peripheral T cell lymphoma
  • B ALL
  • Burkitt's lymphoma
  • Burkitt's-like lymphoma
  • Centroblastic lymphoma
  • Immunoblastic lymphoma
  • Large cell mediastinal B cell lymphoma
  • Other peripheral B cell lymphoma
  • Large cell anaplastic lymphoma
  • Lymphohistiocytic lymphoma
Treated according to the EURO-LB 02 protocol Treated according to the BFM 04 protocol Treated according to the ALCL 99 protocol

 

Radiation therapy is not included in primary treatment for any of the of the therapy groups, except in the case of CNS involvement in children > 5 years.

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