Lymphoma - Hodgkin - Childhood

ON THIS PAGE: You will find information about the estimated number of children and teens who will be diagnosed with Hodgkin lymphoma each year. You will also read general information on surviving the disease. Remember, survival rates depend on several factors, and no 2 people with cancer are the same. Use the menu to see other pages.

Every person is different, with different factors influencing their risk of being diagnosed with this cancer and the chance of recovery after a diagnosis. It is important to talk with your doctor about any questions you have around the general statistics provided below and what they may mean for your child individually. The original sources for these statistics are provided at the bottom of this page.

How many children and teens are diagnosed with Hodgkin lymphoma?

Hodgkin lymphoma makes up 3% of cancer in children 14 and under. The disease is the most commonly diagnosed cancer in teens between the ages of 15 and 19, accounting for 11% of all cancer cases in this age group. Hodgkin lymphoma is also common in young adults, particularly those who are in their 20s. It is also common in adults older than 55. It is rare in children under age 5.

What is the survival rate for children and teens with Hodgkin lymphoma?

There are different types of statistics that can help doctors evaluate a person’s chance of recovery from Hodgkin lymphoma. These are called survival statistics. A specific type of survival statistic is called the relative survival rate. It is often used to predict how having cancer may affect life expectancy. Relative survival rate looks at how likely people with Hodgkin lymphoma are to survive for a certain amount of time after their initial diagnosis or start of treatment compared to the expected survival of similar people without this cancer.

Example: Here is an example to help explain what a relative survival rate means. Please note this is only an example and not specific to this type of cancer.  Let’s assume that the 5-year relative survival rate for a specific type of cancer is 90%. “Percent” means how many out of 100. Imagine there are 1,000 people without cancer, and based on their age and other characteristics, you expect 900 of the 1,000 to be alive in 5 years. Also imagine there are another 1,000 people similar in age and other characteristics as the first 1,000, but they all have the specific type of cancer that has a 5-year survival rate of 90%. This means it is expected that 810 of the people with the specific cancer (90% of 900) will be alive in 5 years.

It is important to remember that statistics on the survival rates for children and teens with Hodgkin lymphoma are only an estimate. They cannot tell an individual person if cancer will or will not shorten their life. Instead, these statistics describe trends in groups of people previously diagnosed with the same disease, including specific stages of the disease.

The 5-year relative survival rate for children 14 and under with Hodgkin lymphoma is 99%. The 5-year relative survival rate for teens ages 15 to 19 is 98%.

The survival rates for Hodgkin lymphoma in children and teens vary based on several factors. These include the stage of cancer, the risk group of the lymphoma, a person’s age and general health, and how well the treatment plan works.

The survival rates for Hodgkin lymphoma on this page are based on children and teens diagnosed between 2012 and 2018. Experts measure the survival statistics every several years. This means the estimate may not reflect the results of advancements in how childhood Hodgkin lymphoma is diagnosed or treated from the last 5 years. Talk with your child’s doctor if you have any questions about this information. Learn more about understanding statistics .

Statistics adapted from the American Cancer Society's (ACS) publication, Cancer Facts & Figures 2023 , and the ACS website. Additional source was : Seigel R, et al.: Cancer Statistics 2023 . CA: A Cancer Journal for Clinicians . 2023 Jan; 73(1):17–48. doi/full/10.3322/caac.21763 . (All sources accessed February 2023.)

The next section in this guide is Medical Illustrations . It offers a drawing of body parts often affected by childhood Hodgkin lymphoma. Use the menu to choose a different section to read in this guide.

ON THIS PAGE : You will find out more about the factors that increase the chance of a child or teen developing Hodgkin lymphoma. Use the menu to see other pages.

A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors often influence the development of cancer, most do not directly cause cancer. Some children with several risk factors never develop cancer, while others with no known risk factors do.

The cause of Hodgkin lymphoma is generally unknown, although the Epstein-Barr virus (EBV) may play a role in the development of this cancer in approximately 30% of children and teens. This is the virus that causes mononucleosis or “mono.”

People with immune system problems also have a higher risk of developing Hodgkin lymphoma. This group includes:

• Children born with the hereditary condition ataxia telangiectasia , which causes immune system problems

• Children with human immunodeficiency virus (HIV), the virus that causes acquired immune deficiency syndrome (AIDS)

• Children who are taking medication that suppresses the immune system following an organ transplant

The next section in this guide is Symptoms and Signs . It explains what changes or medical problems childhood Hodgkin lymphoma can cause. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will find a list of common tests, procedures, and scans that doctors can use to find the cause of a medical problem. Use the menu to see other pages.

Doctors use many tests to find, or diagnose, cancer. They also do tests to learn if cancer has spread to another part of the body from where it started. If the cancer has spread, it is called metastasis. Doctors may also do tests to learn which treatments could work best.

For most types of cancer, a biopsy is the only sure way for the doctor to know if an area of the body has cancer. In a biopsy, the doctor takes a small sample of tissue for testing in a laboratory. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis.

How childhood Hodgkin lymphoma is diagnosed

There are many tests used for diagnosing childhood Hodgkin lymphoma. Not all tests described here will be used for every person, and the timing and sequence of these tests may vary depending on your child's specific situation. Your child’s doctor may consider these factors when choosing a diagnostic test:

• The type of cancer suspected

• Your child’s signs and symptoms

• Your child's age and general health

• The results of earlier medical tests

The following tests may be performed to diagnose Hodgkin lymphoma:

• Physical examination/Blood tests. Children tend to have larger lymph nodes than adults. Usually, a child has enlarged lymph nodes for several weeks or months before a doctor suspects Hodgkin lymphoma, which is uncommon in this age group. The doctor first looks for signs of a more common infection that may cause the lymph nodes to swell and may prescribe antibiotics.

  If swelling in the lymph nodes does not go down after a course of antibiotics, the swelling may be caused by something other than an infection. In these instances, the doctor does a physical examination of all the lymph node areas, the liver, and the spleen, which may be enlarged in children or teens with Hodgkin lymphoma. Blood tests may also be done to check blood counts and evaluate how the liver and kidneys are working. There is no specific blood test for Hodgkin lymphoma, but changes in blood counts, such as unexplained anemia or a low number of red blood cells, are sometimes more common in people with Hodgkin lymphoma.

• Biopsy. If the lymph nodes do not feel normal when the doctor examines them and do not respond to antibiotics, the doctor will check tissue from the abnormal lymph node for cancer cells. The process of removing the tissue for examination is called a biopsy .

  Hodgkin lymphoma makes a distinctive kind of abnormal cell, called a Reed-Sternberg cell, which is easily identified under the microscope. The only way to diagnose Hodgkin lymphoma is to look at the tissue from an abnormal lymph node under the microscope. A pathologist is the specialist who analyzes the sample(s). A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease.

  To perform a standard biopsy for Hodgkin lymphoma, a surgeon cuts through the skin and removes an entire lymph node or a piece of a mass of lymph nodes. In children, a lymph node biopsy is usually performed with general anesthesia or conscious sedation, in which the child is awake but the pain and discomfort are lessened with medication.

  Sometimes, a doctor may first try to obtain tissue from the lymph node by doing a fine needle aspiration biopsy . In this test, a thin needle is used to remove small amounts of fluid and tissue from the lymph node. This type of biopsy may not provide enough tissue to diagnose the disease, so it is recommended only when a standard, surgical biopsy cannot be done.

If a biopsy confirms the diagnosis of Hodgkin lymphoma, several tests and scans can help the doctor learn more about the disease and, through a process called staging , show how far the disease has spread. The tests and scans can also show how well treatment is working. Tests may include:

• X-ray. An x-ray is a way to create a picture of the structures inside of the body using a small amount of radiation. For instance, a chest x-ray will show whether lymph nodes in the mediastinum are enlarged. A mediastinal tumor that takes up one-third or more of the chest cavity is considered "bulky." It may cause coughing or breathing problems by narrowing the airway.

• Computed tomography (CT) scan . A CT scan takes pictures of the inside of the body using x-rays taken from different angles. A computer combines these pictures into a detailed, 3-dimensional or 3D image that shows any abnormalities or tumors. A CT scan can be used to measure the tumor’s size. A special dye called a contrast medium is given before the scan to provide better detail on the image. The dye can be injected into a patient’s vein and/or given as a pill or liquid to swallow. The CT scan shows if lymph nodes in the chest or abdomen are enlarged, which may be a sign of cancer. Also, this test will show if other organs, such as the lungs, liver, or spleen, are involved.

• Magnetic resonance imaging (MRI) . An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. MRI can be used to measure the tumor’s size. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein and/or given as a pill or liquid to swallow. This test may be used instead of or in addition to a CT scan at diagnosis or during follow-up care to check for lymphoma in the abdomen, bones, or lymph nodes in the chest.

• Positron emission tomography (PET) scan or PET-CT scan. A PET-CT scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive sugar substance is injected into the patient’s body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. However, the amount of radiation in the substance is too low to be harmful. A scanner then detects this substance to produce images of the inside of the body. PET scans are often used to add to the information gathered from a CT scan and physical examination. PET scans are an important tool used to evaluate how well treatment is working for Hodgkin lymphoma. Before treatment, areas of active Hodgkin lymphoma appear bright on the scan in most people. During and after treatment, these bright areas usually go away as the cancer cells are being destroyed. This test can reassure families and doctors—without doing a biopsy—that scar tissue still present on a CT scan after treatment does not contain active cancer cells, and it will help to determine how much additional treatment is necessary.

• Bone marrow biopsy. Hodgkin lymphoma rarely spreads to the bone marrow in children with disease that is only in the lymphatic system. Bone marrow has both a solid and liquid part. In many cases, a PET scan (see above) can be used to find out if the lymphoma involves the bone marrow. The doctor may recommend a bone marrow biopsy if they believe that a PET scan will not be effective for your child. A bone marrow biopsy is the removal of a small amount of solid tissue using a needle, usually from bone in the pelvis, which is located in the lower back by the hip. Doctors generally give a type of medication called "anesthesia" beforehand to numb the area, or more commonly, conscious sedation is given while a needle is inserted. Anesthesia is medication that blocks the awareness of pain. Stronger types of anesthesia can also be used to lessen the pain. A pathologist will analyze the sample(s) obtained from the biopsy to determine if the lymphoma involves the bone marrow.

After diagnostic tests are done, your child’s doctor will review the results with you. If the diagnosis is Hodgkin lymphoma, these results also help the doctor describe the cancer. This is called staging.

The next section in this guide is Stages and Groups . It explains the system doctors use to describe the extent of the disease. Use the menu to choose a different section to read in this guide.

ON THIS PAGE : You will learn about the different treatments doctors use for children with Hodgkin lymphoma. Use the menu to see other pages.

In general, cancer in children is uncommon. This means it can be hard for doctors to plan treatments unless they know what has been most effective in other children. That is why more than 60% of children with cancer are treated as part of a clinical trial. A clinical trial is a research study that tests a new approach to treatment. The “standard or care” is the best treatments known based on previous clinical trials. Clinical trials may test such approaches as a new drug, a new combination of existing treatments, or new doses of current therapies. The health and safety of all children participating in clinical trials are closely monitored.

To take advantage of these newer treatments, children with Hodgkin lymphoma should be treated at a specialized cancer center. Doctors at these centers have extensive experience in treating children with cancer and have access to the latest research. A doctor who specializes in treating children with cancer is called a pediatric oncologist. If a pediatric cancer center is not nearby, general cancer centers sometimes have pediatric specialists who are able to be part of your child’s care.

How Hodgkin lymphoma is treated in children and teens

In many cases, a team of doctors works with a child and the family to provide care. This is called a multidisciplinary team . Pediatric cancer centers often have extra support services for patients and their families, such as child life specialists, dietitians, physical and occupational therapists, social workers, counselors, and periods of time for quality of life. Special activities and programs to help your child and family cope may also be available. An increasing number of pediatric cancer centers also have services for teenagers and young adults . Sometimes, adult cancer centers also offer special services and clinical trials for teens and young adults with cancer.

Treatment options and recommendations depend on several factors, including the type and stage of cancer, its risk grouping, possible side effects, the family’s preferences, and the patient's overall health. Take time to learn about all of your child’s treatment options and be sure to ask questions about things that are unclear. Talk with your child’s doctor about the goals of each treatment and what your child can expect while receiving the treatment. These types of talks are called “shared decision-making.” Shared decision-making is when your family and the doctors work together to choose treatments that fit the goals of your child’s care. Shared decision-making is particularly important for Hodgkin lymphoma because there are different treatment options. Learn more about making treatment decisions .

In general, a treatment plan for Hodgkin lymphoma includes chemotherapy and/or radiation therapy. These treatments are described below. Surgery is not commonly used, although it may sometimes be recommended if the involved lymph nodes can be completely removed by surgery and the c a ncer is a less common but very specific type of Hodgkin lymphoma called nodular lymphocyte predominant Hodgkin lymphoma.

The amount and type of treatment used to treat Hodgkin lymphoma depends on how many lymph node areas are involved and how large the lymph nodes have grown. Children with more high-risk or bulky disease may need more cycles of chemotherapy and radiation therapy than children with low-risk disease. Ongoing studies of childhood Hodgkin lymphoma are trying to further reduce the amount of treatment to avoid long-term side effects. For example, some treatments can potentially affect the patient’s ability to have a child in the future. If this is the case with your child's treatment, it is important to talk with your child’s doctor about ways to preserve fertility before treatment begins.

The common types of treatment used for Hodgkin lymphoma for children and teens are described below. Your child’s care plan also includes treatment for symptoms and side effects, an important part of cancer care.

• Chemotherapy

• Targeted therapy

• Immunotherapy

• Radiation therapy

• Stem cell/bone marrow transplantation

• Physical, emotional, and social effects of cancer

• Remission and the chance of recurrence

• If treatment does not work

Therapies using medication

The treatment plan may include medications to destroy cancer cells. Medication may be given through the bloodstream or by mouth in order to reach cancer cells throughout the body. When a drug is given this way, it is called systemic therapy.

Medication for childhood Hodgkin lymphoma is given by a pediatric hematologist-oncologist, a doctor who specializes in treating lymphoma in children and teens using medication.

Medications are often given through an intravenous (IV) tube placed into a vein using a needle or as a pill or capsule that is swallowed (orally). If your child is given oral medications, be sure to ask your health care team about how to safely store and handle them.

The types of medications used for childhood Hodgkin lymphoma include:

• Chemotherapy

• Targeted therapy

• Immunotherapy

Each of these types of therapies is discussed below in more detail. A person may receive 1 type of medication at a time or a combination of medications given at the same time. They can also be given as part of a treatment plan that includes surgery and/or radiation therapy.

The medications used to treat cancer are continually being evaluated. Talking with your child’s doctor is often the best way to learn about the medications prescribed for your child, their purpose, and their potential side effects or interactions with other medications.

It is also important to let your doctor know if your child is taking any other prescription or over-the-counter medications or supplements. Herbs, supplements, and other drugs can interact with cancer medications, causing unwanted side effects or reduced effectiveness. Learn more about your child’s prescriptions by using searchable drug databases .

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by keeping the cancer cells from growing, dividing, and making more cells.

A chemotherapy regimen, or schedule, usually consists of a specific number of cycles given over a set period of time. A patient may receive 1 drug at a time or a combination of different drugs given at the same time.

In the past, children treated for Hodgkin lymphoma received 1 of 2 combinations of chemotherapy:

• MOPP: Mechlorethamine (Mustargen), prednisone (multiple brand names), procarbazine (Matulane), and vincristine (Vincasar)

• ABVD: Bleomycin (available as a generic drug), dacarbazine (DTIC-Dome), doxorubicin (available as a generic drug), and vinblastine (available as a generic drug)

Many of the same drugs included in the original MOPP and ABVD regimens are still used in current treatment plans and combinations for children and teens with Hodgkin lymphoma but at lower total doses.

Newer treatment combinations for children may replace mechlorethamine with cyclophosphamide (available as a generic drug) and procarbazine with etoposide (Etopophos) or dacarbazine to reduce the risk of causing infertility, which is the inability to have a child in the future. More recently, treatment plans for high-risk Hodgkin lymphoma use more intensive combinations of drugs, called dose-dense, over shorter periods of time. These are therapies with combinations of drugs called ABVE-PC, OEPA-COPDac, AEPA-CAPDac, and BEACOPP.

Doctors may recommend treatment with chemotherapy alone or a combination of chemotherapy and radiation therapy (see below). Current chemotherapy regimens evaluate the lymphoma’s response to treatment early in the treatment schedule. Response is typically measured with computed tomography (CT) scan, a positron emission tomography (PET) scan, or a combination of the 2 (see Diagnosis ). A child with lymphoma that responds more quickly to treatment may need less treatment than children with lymphoma that responds to treatment more slowly. For earlier-stage lymphoma, many research studies do not include radiation therapy for children whose disease is treated successfully with chemotherapy. For later-stage disease, current clinical trials often include radiation therapy.

For children with bulky disease, many doctors feel that combination treatment gives the best chance for curing the disease by incorporating 2 different ways to attack the cancer cells. In combination treatment, doctors reduce the total doses of individual chemotherapies and radiation therapy, which should reduce the risks of developing long-term side effects. The most important consideration is to use enough treatment to cure the disease with the first treatment plan. This is because the disease that comes back must be treated with higher-intensity treatments.

Because cancer medications attack rapidly dividing cells, including those in normal tissues such as the hair, lining of the mouth, intestines, and bone marrow, children receiving chemotherapy may lose their hair, develop mouth sores, or have nausea and vomiting. In addition, chemotherapy may lower the body’s resistance to infection, lead to increased risk of bruising and bleeding, and cause fatigue. These side effects usually can be controlled during treatment and go away after chemotherapy is completed. The severity of the side effects depends on the type and amount of the drug being given and the length of time the child receives the drug. Learn more about long-term side effects of chemotherapy in the Follow-Up Care section .

Learn more about the basics of chemotherapy .

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Targeted therapy

Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells and limits damage to healthy cells.

Targeted therapy for childhood Hodgkin lymphoma includes:

• Brentuximab vedotin (Adcetris). Brentuximab vedotin is an antibody-drug conjugate. It uses a targeted therapy to attach to a protein called CD30 that is present in many lymphoma cells. The drug then releases a small amount of a toxin directly into the lymphoma cells to kill them. Past and ongoing clinical trials are studying adding brentuximab vedotin to standard chemotherapy regimens to find out if Hodgkin lymphoma can be more effectively cured with fewer side effects.

• Rituximab (Rituxan). Rituximab is a monoclonal antibody. It recognizes and attaches to the CD20 protein in the lymphoma cells, and it does not affect cells that do not have that protein. Rituximab is typically only used for the nodular lymphocyte predominant type of Hodgkin lymphoma.

Talk with your doctor about possible side effects for a specific medication and how they can be managed. Learn more about the basics of targeted treatments .

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Immunotherapy

Immunotherapy uses the body's natural defenses to fight cancer by improving the immune system’s ability to attack cancer cells. Immunotherapy has typically been reserved for treating only recurrent or refractory disease, but clinical trials are beginning to study using it as a first-line treatment.

A specific type of immunotherapy called immune checkpoint inhibitors are used to treat childhood Hodgkin lymphoma. These 2 drugs target a specific pathway called PD-1:

• Pembrolizumab (Keytruda)

• Nivolumab (Opdivo)

Different types of immunotherapy can cause different side effects. Common side effects include skin reactions, flu-like symptoms, diarrhea, and weight changes. Talk with your doctor about possible side effects for the immunotherapy recommended for you. Learn more about the basics of immunotherapy .

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Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body.

A radiation therapy regimen, or schedule, usually consists of a specific number of treatments given over a set period of time.

In the past, treatments for Hodgkin lymphoma used high doses of radiation therapy to all lymph node areas. As they grew older, children treated this way developed problems with muscle and bone growth and had a higher risk of heart disease and second cancers in adulthood. Today, treatment with radiation therapy alone is never used for children, but it may be given to areas of lymph nodes where chemotherapy alone is not enough to eliminate the cancer cells. This approach reduces the amount of radiation therapy to the body compared with previous regimens.

The need for radiation therapy is determined by the stage of disease and how well the disease responds to chemotherapy. Clinical trials are currently in progress to identify patients whose disease can be treated successfully using chemotherapy alone (see Latest Research ). However, radiation therapy is a very effective treatment for Hodgkin lymphoma and plays a major role in curing the disease for some patients.

In general, short-term side effects from radiation therapy include tiredness, sore throat, dry mouth, mild skin reactions, upset stomach, and loose bowel movements, depending on the parts of the body affected by radiation treatment. Long-term side effects of radiation therapy may include growth problems of bones and soft tissues; dental, thyroid, heart, and lung problems; and second cancers. In particular, girls treated for Hodgkin lymphoma with radiation to the mediastinum (chest area) are at increased risk of breast cancer. Therefore, newer radiation therapy approaches pay close attention to reducing breast tissue exposure to radiation. Learn more about the basics of radiation therapy .

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Stem cell/bone marrow transplantation

Often when high doses of chemotherapy or radiation therapy are used to treat recurrent Hodgkin lymphoma, the bone marrow becomes damaged and cannot produce healthy blood cells. To replace those lost cells, a stem cell/bone marrow transplant may be recommended.

This type of transplant is a medical procedure in which bone marrow that contains cancer is replaced by highly specialized cells. These cells, called hematopoietic stem cells, develop into healthy bone marrow. Hematopoietic stem cells are blood-forming cells found both in the bloodstream and in the bone marrow. This procedure is called a bone marrow transplant, stem cell transplant, or hematopoietic stem cell transplant.

Before recommending transplantation, doctors will talk with you about the risks of this treatment. They will also consider several other factors, such as the type of cancer, results of any previous treatment, and your child’s age and general health.

There are 2 types of hematopoietic stem cell transplantation, depending on the source of the blood stem cells: allogeneic (ALLO) and autologous (AUTO). ALLO uses donated stem cells, while AUTO uses the child’s own stem cells. An AUTO transplant is the type most commonly used for Hodgkin lymphoma. An ALLO transplant is not used as frequently for patients with recurrent Hodgkin lymphoma because of the greater risks of serious side effects.

In both types of transplant, the goal is to destroy all of the cancer cells in the bone marrow, blood, and other parts of the body using high doses of chemotherapy and/or radiation therapy and then allow replacement blood stem cells to create healthy bone marrow.

Side effects depend on the type of transplant, your child’s general health, and other factors. Learn more about the basics of bone marrow and stem cell transplantation .

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Physical, emotional, and social effects of cancer

Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your child’s care that is included along with treatments intended to slow, stop, or eliminate the cancer.

Palliative care focuses on improving how your child feels during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Some centers call this supportive care or quality of life care. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive this care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.

Palliative, supportive, and quality-of-life treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. Your child may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy.

Before treatment begins, talk with your child’s doctor about the goals of each treatment in the recommended treatment plan. You should also talk about the possible side effects of the specific treatment plan and palliative care options. Many patients also benefit from talking with a social worker and participating in support groups. Ask your doctor about these resources, too.

During treatment, your child’s health care team may ask you to answer questions about your child’s symptoms and side effects and to describe each problem. Be sure to tell the health care team if your child is experiencing a problem. This helps the health care team treat any symptoms and side effects as quickly as possible. It can also help prevent more serious problems in the future.

Learn more about the importance of tracking side effects in another part of this guide. Learn more about palliative care in a separate section of this website.

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Remission and the chance of recurrence

A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having “no evidence of disease” or NED.

A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. While many remissions are permanent it is important to talk with your child’s doctor about the possibility of the cancer returning. Understanding your child's risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence .

If the cancer returns after the original treatment, it is called recurrent cancer. The disease can come back in the same area in which it began or in a new area of the body.

If a recurrence happens, a new cycle of testing will begin again to learn as much as possible about it. After this testing is done, you and your child’s doctor will talk about the treatment options. Often the treatment plan will include the treatment described above, such as chemotherapy and radiation therapy, but they may be used in a different combination or given at a different pace. Your child’s doctor may suggest clinical trials that are studying new ways to treat recurrent Hodgkin lymphoma. Whichever treatment plan you choose, palliative and supportive care will be important for relieving symptoms and side effects.

Treatment for recurrent Hodgkin lymphoma depends on where the disease recurs, the type of treatment the child has had previously, and the length of time since the first treatment was completed. For example, if chemotherapy was given initially, then the child may be given another round of chemotherapy using different drugs.

If the disease has come back very soon after the first treatment or after the use of chemotherapy and radiation therapy, more aggressive therapy may be recommended to increase the chances of keeping the disease in remission. This may include bone marrow/stem cell transplantation. A chemotherapy combination like ifosfamide (Ifex) and vinorelbine (available as a generic drug) is typically used to shrink sites of recurrent disease before a bone marrow transplant.

Other combinations that have been shown to have an effect in recurrent Hodgkin lymphoma are gemcitabine (Gemzar) and vinorelbine or bendamustine (Treanda) and brentuximab vedotin (Adcetris). These are examples of some possible drug combinations, but other treatment plans are also effective in treating this disease. Such combination names include ICE, MIED, DHAP, ESHPA, APE, and DECAL.

Other, newer treatments that scientists are studying include targeted therapies called monoclonal antibodies. Each monoclonal antibody is directed against a specific protein on the surface of cancer cells, and it does not affect cells that do not have that protein. Monoclonal antibodies being studied include rituximab and brentuximab vedotin (see Targeted Therapy, above). It is important to talk with your child’s doctor about which treatment plan is best.

If cancer recurs, patients and their families often experience emotions such as disbelief or fear. Families are encouraged to talk with their health care team about these feelings and ask about support services to help with coping. Learn more about dealing with cancer recurrence .

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If treatment does not work

Although treatment is successful for many children with Hodgkin lymphoma, sometimes it is not. If a child’s cancer cannot be cured or controlled, this is called advanced or terminal cancer. This diagnosis is stressful, and advanced cancer may be difficult to discuss. However, it is important to have open and honest conversations with your child’s health care team to express your family’s feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients, and their families and is there to help.

Hospice care is designed to provide the best possible quality of life for people who are expected to live less than 6 months. Parents or guardians are encouraged talk with the health care team about hospice options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable option for many families. Some children may be happier and more comfortable if they can attend school part-time or keep up other activities and social connections. The child’s health care team can help parents or guardians decide on an appropriate level of activity. Making sure a child is physically comfortable and free from pain is extremely important as part of end-of-life care. Learn more about caring for a terminally ill child and advanced cancer care planning .

The death of a child is an enormous tragedy, and families may need support to help them cope with the loss. Pediatric cancer centers often have professional staff and support groups to help with the process of grieving. Learn more on grieving the loss of a child .

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The next section in this guide is About Clinical Trials . It offers more information about research studies that are focused on finding better ways to care for people with cancer. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will read about the scientific research being done to learn more about Hodgkin lymphoma and how to treat it. Use the menu to see other pages.

Doctors are working to learn more about Hodgkin lymphoma, ways to prevent it, how to best treat it, and how to provide the best care to children and teens diagnosed with this disease. The following areas of research may include new options for patients through clinical trials. Always talk with your child’s doctor about the best diagnostic and treatment options for your child.

• Targeted therapy. Targeted therapy is a treatment that targets specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. As mentioned in Types of Treatment , recent studies are evaluating antibodies directed against specific proteins on the Hodgkin lymphoma cells. Learn more about the basics of targeted treatments .

• Immunotherapy. Immunotherapy uses the body's natural defenses to fight cancer by improving your immune system’s ability to attack cancer cells. As outlined in the Types of Treatment section, drugs such as pembrolizumab and nivolumab are specific types of immunotherapy called immune checkpoint inhibitors that target a specific pathway called PD-1 to treat childhood Hodgkin lymphoma. Learn more about the basics of immunotherapy .

• ALLO transplantation. As explained in the Types of Treatment section, stem cell/bone marrow transplantation is sometimes used to treat Hodgkin lymphoma. Doctors are researching increasing the use of transplantation, including the use of ALLO transplantation using donor blood stem cells to replace the patient’s bone marrow.

• Personalized treatments. The major goal of Hodgkin lymphoma research is to continue to maintain and/or improve treatment effectiveness while reducing long-term side effects. More sophisticated ways to measure the disease's early response to treatment are being studied as a way of tailoring therapy to each patient. Based on how the disease responds to the treatment, some individuals may require less therapy, while others may need more intensive therapy, sometimes including radiation therapy. Understanding what specific treatments an individual needs will be important for balancing the treatment effectiveness and side effects for each patient.

• Palliative/quality-of-life/supportive care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current Hodgkin lymphoma treatments in order to improve comfort and quality of life for patients.

Looking for More About Latest Research?

If you would like more information about the latest areas of research in Hodgkin lymphoma, explore these related items that take you outside of this guide:

• To find clinical trials specific to your child's diagnosis, talk with your child’s doctor or search online clinical trial databases .

• To read research and news about childhood cancers and/or lymphoma , visit the Cancer.Net Blog.

• Visit the website of Conquer Cancer, the ASCO Foundation, to find out how to help support cancer research. Please note that this link takes you to a different ASCO website.

The next section in this guide is Coping with Treatment . It offers some guidance on how to cope with the physical, emotional, social, and financial changes that cancer and its treatment can bring. Use the menu to choose a different section to read in this guide.

ON THIS PAGE : You will read about your child’s medical care after cancer treatment is finished and why this follow-up care is important. To see other pages, use the menu.

Care for children and teens diagnosed with Hodgkin lymphoma does not end when active treatment has finished. Your child’s health care team will continue to check that the cancer has not come back, manage any side effects, and monitor your child’s overall health. This is called follow-up care. All children treated for cancer, including Hodgkin lymphoma, should have life-long, follow-up care.

Your child’s follow-up care may include regular physical examinations, medical tests, or both. Doctors want to keep track of your child’s recovery in the months and years ahead.

Cancer rehabilitation may be recommended, and this could mean any of a wide range of services such as physical therapy, family or individual counseling, nutritional planning, and/or educational assistance. The goal of rehabilitation is to help survivors and their families regain control over many aspects of their lives and remain as independent as possible. Learn more about cancer rehabilitation.

Learn more about the importance of follow-up care .

Watching for recurrence

One goal of follow-up care is to check for a recurrence, which means that the cancer has come back. Cancer recurs because small areas of cancer cells may remain undetected in the body. Over time, these cells may increase in number until they show up on test results or cause signs or symptoms.

During follow-up care, a doctor familiar with your child’s medical history can give you personalized information about the risk of recurrence. Your child's doctor will ask specific questions about your child’s health. Some children may have blood tests or imaging tests as part of regular follow-up care, but testing recommendations depend on several factors including the type, stage, and risk group of lymphoma first diagnosed and the types of treatment given.

The anticipation before having a follow-up test or waiting for test results may add stress to you or a family member. This is sometimes called “scanxiety.” Learn more about how to cope with this type of stress .

Managing long-term and late side effects of childhood cancer

Sometimes side effects may linger beyond the active treatment period. These are called long-term side effects . In addition, other side effects called late effects may develop months or even years after treatment has ended. Late effects can occur almost anywhere in the body. They include physical problems, such as heart and lung problems, fertility problems, and second cancers, which is a new cancer that happens in someone who has had cancer before. They also include emotional problems, such as anxiety and depression, and problems with memory, thinking, attention, and learning. The risk of specific late effects is directly related to the specific chemotherapy drugs in the treatment plan and areas treated by radiation therapy and surgery.

Based on the type of treatment your child received, the doctor will recommend what examinations and tests are needed to check for late effects. The long-term side effects of chemotherapy also depend on the type and total dose of each drug. These include:

• Heart problems after doxorubicin or radiation therapy

• Lung problems after bleomycin or radiation therapy

• Thyroid problems after radiation therapy

• Secondary cancer after radiation therapy or chemotherapy

• Fertility problems after cyclophosphamide, mechlorethamine, procarbazine, or pelvic radiation

In addition, children who had their spleen removed (splenectomy) have an ongoing chance of serious infection. Splenectomy is no longer routinely performed for Hodgkin lymphoma, but it may affect survivors of Hodgkin lymphoma who were treated many years ago. Rarely, children with Hodgkin lymphoma develop a specific second cancer, called acute myeloid leukemia , because of chemotherapy’s effects on bone marrow function. Fortunately, the risk of long-term side effects is much lower with newer treatment plans that limit the doses of drugs and radiation therapy that cause serious health problems.

For most Hodgkin lymphoma survivors, the medical side effects of treatment do not significantly affect how long someone lives. However, Hodgkin lymphoma survivors report significant concerns regarding their health compared with other survivors of childhood cancer. This may result from the social and emotional effects of treatment during adolescence, when the teen may feel different from their peers and/or experience social isolation . In addition, some Hodgkin lymphoma survivors experience long-term fatigue that may require lifestyle changes, such as taking a reduced course load at college or choosing employment that is consistent with their energy level. Learn more about late effects for childhood and young adult cancer survivors .

Follow-up care should address your child’s quality of life, including any developmental or emotional concerns.

Ongoing follow-up care by health care professionals experienced in long-term side effects is important. Important preventive health care measures for survivors of childhood Hodgkin lymphoma include regular breast cancer screening in patients who received mediastinal radiation therapy; not smoking due to enhanced lung cancer risk, especially after receiving bleomycin or radiation therapy; and reducing the risk for heart disease through exercise, diet, and medication. Such preventive steps may foster better, long-term health outcomes and may offer people a sense of control over their own health.

The Children's Oncology Group (COG) has studied the physical and psychological effects that childhood cancer survivors face. Based on these studies, COG has created recommendations for long-term follow-up care for childhood, adolescent, and young adult cancer survivors that can be found on a separate website: www.survivorshipguidelines.org .

Keeping a child’s personal health record

You are encouraged to organize and keep a personal record of your child’s medical information. The doctor should help you create this. That way, as the child enters adulthood, they have a clear, written history of the diagnosis, the treatments, and the doctor’s recommendations about the schedule for follow-up care. These documents are often referred to as cancer treatment summaries and/or survivorship care plans. ASCO offers forms to help keep track of the cancer treatment your child received and develop a survivorship care plan when treatment is completed.

Some children continue to see their oncologist, while others transition back to the care of their pediatrician, primary care doctor, or another health care professional. This decision depends on several factors, including the type and stage of cancer, side effects, health insurance rules, and your family’s personal preferences. Talk with the health care team about your child’s ongoing medical care and any concerns you have about their future health.

If a doctor who was not directly involved in your child’s cancer care will lead the follow-up care, be sure to share the cancer treatment summary and survivorship care plan forms with them and with all future health care providers. Details about the specific cancer treatment given are very valuable to the health care professionals who will care for your child throughout their lifetime.

The next section in this guide is Survivorship . It describes how to cope with challenges in everyday life after a cancer diagnosis. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will find some questions to ask your child's doctor or other members of the health care team, to help you better understand your child’s diagnosis, treatment plan, and overall care. Use the menu to see other pages.

Talking often with your health care team to make informed decisions about your child’s health care. These suggested questions are a starting point to help you learn more about your child's cancer care and treatment. You are also encouraged to ask additional questions that are important to you. You may want to print this list and bring it to your child’s next appointment, or download Cancer.Net’s free mobile app for a digital list and other interactive tools to manage your child’s care. It may also be helpful to ask a family member or friend to come with you to appointments to help take notes.

Questions to ask after getting a diagnosis

• What type of lymphoma has been diagnosed?

• What subtype of Hodgkin lymphoma does my child have?

• What is the stage of the disease? What is the risk grouping?

• Can you explain my child’s pathology report (laboratory test results) to me?

Questions to ask about choosing a treatment and managing side effects

• What are my child’s treatment options?

• What clinical trials are available for my child? Where are they located, and how do I find out more about them?

• What treatment plan do you recommend? Why?

• What is the goal of each treatment? Is it to eliminate the cancer, help my child feel better, or both?

• What are the possible side effects of this treatment plan, both in the short term and the long term?

• Who will be part of my child’s health care team, and what does each member do?

• Who will be leading my child’s overall treatment?

• How will this treatment affect my child’s daily life? Will they be able to attend school and perform their usual activities?

• Could this treatment affect my child’s ability to become pregnant or have children in the future? If so, should my family talk with a fertility specialist before cancer treatment begins?

• If I’m worried about managing the costs of cancer care, who can help me?

• What support services are available to my child? To my family?

• If I have questions or problems, who should I call?

Questions to ask about having therapies using medications

• What type of treatment, or combination of treatments, is recommended?

• What is the goal of this treatment?

• How long will it take to give this treatment?

• Will my child receive this treatment at a hospital or clinic? Or will they take it at home?

• What side effects can we expect during my child's treatment?

• Who should I contact about any side effects my child experiences? And how soon?

• What are the possible long-term or late effects of having this treatment?

• What can be done to prevent or relieve the side effects?

Questions to ask about having radiation therapy

• What type of radiation therapy is recommended?

• What is the goal of this treatment?

• How long will it take to give this treatment?

• What side effects can we expect during my child's treatment?

• Who should I contact about any side effects my child experiences? And how soon?

• What are the possible long-term or late effects of having this treatment?

• What can be done to prevent or relieve the side effects?

Questions to ask about planning follow-up care

• What is the chance that the cancer will come back? Should I watch for specific signs or symptoms?

• What long-term side effects or late effects are possible based on the cancer treatment my child received?

• What follow-up tests will my child need, and how often will those tests be needed?

• How do I get a treatment summary and survivorship care plan to keep in my child's personal records?

• Who will be leading my child’s follow-up care?

• What survivorship support services are available to my child? To my family?

The next section in this guide is Additional Resources . It offers more resources on this website that may be helpful to you. Use the menu to choose a different section to read in this guide.