Treatments for recurrent or refractory childhood HL

Recurrent (relapsed) childhood Hodgkin lymphoma (HL) means that the cancer has come back after treatment. Primary refractory disease means the cancer is resistant to or didn’t respond to the first treatment.

Recurrent childhood HL may come back in the same place as the original cancer, or it may come back in another part of the body.

Treatment for recurrent or refractory childhood HL depends on:

• the treatment that the child received before
• how much time has passed since initial treatment
• the stage of HL at relapse
• response to second treatment

Treatment options for recurrent childhood HL include chemotherapy, stem cell transplant, targeted therapy and radiation therapy.

Chemotherapy is the primary treatment for recurrent or refractory childhood HL. Chemotherapy combinations that may be used include:

• ICE – ifosfamide (Ifex), carboplatin (Paraplatin, Paraplatin AQ) and etoposide (Vepesid, VP-16)
• ifosfamide and vinorelbine (Navelbine)
• vinorelbine and gemcitabine (Gemzar)
• IEP – ifosfamide, etoposide and prednisone, ABVD – doxorubicin (Adriamycin), bleomycin (Blenoxane), vinblastine and dacarbazine, and COPP – cyclophosphamide (Procytox), vincristine (Oncovin), procarbazine hydrochloride (Matulane) and prednisone
• EPIC – etoposide, prednisolone, ifosfamide and cisplatin
• APE – cytarabine (Cytosar), cisplatin and etoposide
• MIED – high-dose methotrexate, ifosfamide, etoposide and dexamethasone (Decadron, Dexasone)

High-dose chemotherapy can also be used, followed by stem cell transplant. Chemotherapy regimens used for stem cell transplant include:

• BEAM – carmustine (BiCNU, BCNU), etoposide, cytarabine and melphalan (Alkeran)
• CBV – cyclophosphamide, carmustine and etoposide
• high-dose gemcitabine, busulfan (Myleran [oral], Busulfex [intravenous]) and melphalan
• melphalan and etoposide

Find out more about chemotherapy for childhood Hodgkin lymphoma.

A stem cell transplant is sometimes used to treat childhood HL that comes back during treatment or soon after treatment is complete.

Doctors are more likely to suggest a stem cell transplant if the child has a brother or sister who is a good match for donation.

Find out more about stem cell transplant for childhood Hodgkin lymphoma.

Targeted therapy uses drugs to target specific molecules (such as proteins) on cancer cells or inside them. These molecules help send signals that tell cells to grow or divide. By targeting these molecules, the drugs stop the growth and spread of cancer cells and limit harm to normal cells.

Children who have recurrent or refractory childhood HL may be treated with targeted therapy drugs such as rituximab (Rituxan) and brentuximab vedotin (Adcetris).

Immune checkpoint inhibitors such as nivolumab (Opdivo), pembrolizumab (Keytruda) and atezolizumab (Tecentriq) may be used in some cases as part of a clinical trial.

Find out more about targeted therapy for childhood Hodgkin lymphoma.

Low-dose radiation therapy may be given to areas that have cancer if they were not already treated with radiation therapy.

Radiation therapy may also be used, along with chemotherapy, before stem cell transplant.

The type of radiation therapy used is external radiation therapy. During external radiation therapy, a machine directs radiation through the skin to the tumour and some of the tissue around it. The dose of radiation and the area treated are kept as small as possible.

Find out more about radiation therapy for childhood Hodgkin lymphoma.

Children with cancer may be treated in a clinical trial. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.