Treatments for childhood diffuse large B-cell lymphoma

The following are treatment options for childhood diffuse large B-cell lymphoma (DLBCL). The healthcare team will suggest treatments based on your child’s health and specific information about the lymphoma. Treatments are often based on the stage or risk group.

Treatments for newly diagnosed childhood diffuse large B-cell lymphoma

Chemotherapy is the main treatment for newly diagnosed DLBCL. Surgery to remove the tumour may be done before chemotherapy if the tumour is only in one area of the body, such as the abdomen.

Chemotherapy

Chemotherapy is the main treatment for childhood DLBCL. How long chemotherapy is given depends on the stage, risk group and treatment plan (protocol). It may be given for 9 weeks to 6 months for stage 1 or 2 DLBCL and for 6 to 8 months for stage 3 or 4 DLBCL.

Chemotherapy drugs are given in different combinations based on different treatment plans. The most common chemotherapy drugs used in combinations for DLBCL include:

  • cyclophosphamide (Procytox)
  • vincristine (Oncovin)
  • prednisone
  • cytarabine (Cytosar)
  • etoposide (Vepesid, VP-16)
  • methotrexate
  • prednisolone
  • doxorubicin (Adriamycin)
  • hydrocortisone
  • dexamethasone (Decadron, Dexasone)
  • daunorubicin (Cerubidine, daunomycin)
  • asparaginase (Kidrolase)
  • mercaptopurine (Purinethol)
  • thioguanine (Lanvis)

Intrathecal chemotherapy may be given to prevent the spread of DLBCL to the brain and spinal cord (called the central nervous system, or CNS) or to treat DLBCL that has spread to the CNS. This means that the drugs are given directly into the cerebrospinal fluid (CSF) around the brain and spinal cord. Intrathecal chemotherapy can include 1 to 3 of the following drugs:

  • methotrexate
  • cytarabine
  • hydrocortisone

Targeted therapy

Targeted therapy with rituximab (Rituxan) may be used in combination with chemotherapy to treat children with DLBCL.

Treatments for recurrent childhood diffuse large B-cell lymphoma

Treatments for recurrent (relapsed) childhood DLBCL may include more intense chemotherapy, with or without targeted therapy (such as rituximab), and an allogeneic or autologous stem cell transplant. Immunotherapy with immune checkpoint inhibitors or CAR T-cell therapy may be used in a clinical trial to treat recurrent childhood DLBCL.

Chemotherapy combinations used for recurrent childhood DLBCL may include:

  • ifosfamide (Ifex), carboplatin (Paraplatin, Paraplatin AQ), etoposide and rituximab

Clinical trials

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.

Expert review and references

  • Allen CE, Kamdar KY, Bollard CM, Gross TG . Malignant non-Hodgkin lymphomas in children. Pizzo PA & Poplack DG (eds.). Principles and Practice of Pediatric Oncology. 7th ed. Philadelphia: Wolters Kluwer; 2016: 23: 587-603.
  • American Cancer Society. Treating Non-Hodgkin Lymphoma in Children. 2017.
  • Gross TG & Perkins SL . Malignant non-Hodgkin lymphomas in children. Pizzo, P. A. & Poplack, D. G. (Eds.). Principles and Practice of Pediatric Oncology. 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2011: 23:pp. 663-682.
  • Johnston JM. Pediatric Non-Hodgkin Lymphoma Treatment and Management. 2018.
  • National Cancer Institute. Childhood Non-Hodgkin Lymphoma Treatment (PDQ®) Patient Version. 2018.
  • National Cancer Institute. Childhood Non-Hodgkin Lymphoma Treatment (PDQ®) Health Professional Version. 2018.
  • Truong TH, Weitzman, S, Arceci RJ . Non-Hodgkin lymphoma of childhood. Wiernik PH, Goldman JM, Dutcher JP & Kyle RA (eds.). Neoplastic Diseases of the Blood. 5th ed. Springer; 2013: 48: pp. 1049-1072.
  • Woods D, McDonald, L . Non-Hodgkin lymphoma. Baggott C, Fochtman D, Foley GV & Patterson Kelly, K (eds.). Nursing Care of Children and Adolescents with Cancer. 4rd ed. APHON; 2011: 29: pp. 1023-1037.