Childhood Hodgkin lymphoma

Because of new and better therapies, cancer survival rates for children have improved dramatically during the last several decades. Scientists continue to search for the causes of childhood lymphoma so they can develop more effective treatments with less toxic side effects. 

Find out more about coping with childhood cancer. 

Caring for Kids and Adolescents with Blood Cancer: A Workbook for Families 

Download or order a copy of the workbook which provides information, resources, and worksheets to use throughout your child's cancer journey. Call an Information Specialist at 800-955-4572 to order a copy.  

Find facts and statistics about childhood Hodgkin lymphoma and other blood cancers.  

Signs and symptoms of Hodgkin lymphoma in children 

The most common symptom of Hodgkin lymphoma is one or more enlarged (swollen) lymph nodes. The enlarged lymph node may be in the neck, upper chest, armpit, abdomen, or groin. The swollen lymph node is usually painless. 

Other signs and symptoms of Hodgkin lymphoma may include: 

• Drenching night sweats*
• Unexplained weight loss*
• Unexplained fever*
• Persistent fatigue
• Persistent cough and shortness of breath (due to enlarged lymph nodes in the chest)
• Itchy skin, especially after bathing
• Decreased appetite
• Abdominal pain or swelling and feeling of fullness (due to an enlarged spleen)
• Occasional pain in lymph nodes

*B symptoms: Fever, drenching night sweats, and loss of more than 10 percent of body weight over six months are sometimes termed "B symptoms."  These symptoms are significant to the prognosis and staging of the disease. 

Some Hodgkin lymphoma symptoms are associated with other, less serious illnesses. However, if you're troubled by any of the above symptoms, see your child’s doctor. 

Childhood Hodgkin lymphoma staging and categories 

Once your child’s hematologist-oncologist confirms a Hodgkin lymphoma diagnosis, they will order more tests to stage your child’s disease. Staging identifies the extent of the disease and where it's located in your body. Some of these tests may be repeated, both during and after therapy, to measure the response to treatment. 

View a 3D model of childhood Hodgkin lymphoma’s impact on the body. Click or tap the "Interact in 3D" button to begin. 

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Hodgkin lymphoma stages 

Doctors use physical examinations, imaging tests, blood tests, and sometimes bone marrow tests to determine the extent of disease. This determination is called "staging."  Staging provides important information for treatment planning. Find the characteristics associated with each of the four stages of Hodgkin lymphoma below. 

Hodgkin lymphoma categories  

In addition to the stage number, the letters “A,” “B,” “E,” or “S” may be used to further classify the stage of Hodgkin lymphoma. 

Category A: The patient does not have B symptoms (fever, drenching night sweats and/or unexplained weight loss greater than 10 percent of body weight over six months). 

Category B: The patient has B symptoms (fever, drenching night sweats, and loss of more than 10 percent of body weight over six months). 

Category E: The patient has Hodgkin lymphoma cells in organs or tissues outside the lymphatic system. 

Category S: The patient has Hodgkin lymphoma cells in the spleen.  

For example, Stage IIB would indicate the patient has: 

• Involvement of two lymph node sites near each other (for example, enlarged lymph nodes in the neck and collarbone area or in the neck and the armpit)
• Fever, excessive sweating, and/or weight loss 

Patients in Category B sometimes require more aggressive treatments. It is important to note that even patients with Stage IV (advanced stage) Hodgkin lymphoma are frequently cured with treatment, despite having lymphoma in many areas of the body. 

Diagnosing Hodgkin lymphoma subtypes in children 

The World Health Organization (WHO) divides Hodgkin lymphoma into two main subtypes: Classical Hodgkin lymphoma (cHL) and Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL)   

It is important to know your subtype because it plays a large part in determining the type of treatment you will receive. 

Classical Hodgkin lymphoma (CHL) 

Classical Hodgkin lymphoma (cHL) is characterized by the presence of both Hodgkin and Reed-Sternberg (RS) cells. RS cells are large, abnormal B lymphocytes that often have more than one nucleus and an owl-like appearance. 

About 95 percent of people with Hodgkin lymphoma have cHL. This subtype is further divided into four distinct subtypes shown in the table below. 

Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) 

Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is characterized by the presence of lymphocyte-predominant cells, sometimes termed “popcorn cells,” which are a variant of RS cells.  

NLPHL affects about 5 percent of Hodgkin lymphoma patients. The following are some characteristics of NLPHL: 

• Most common in 30- to 50-year-old age group
• More common in males
• Slow growing and can relapse many years later
• Highly curable 

After diagnosis: Navigating your child's care 

Navigating your child’s blood cancer care isn’t always simple or straightforward—but we’re here to guide you through it. Whether they’re newly diagnosed or in remission, you’ll find the information, support, and resources you need to navigate every step of your child’s blood cancer journey. 

Visit navigating your care: Children and teens 

Treatment for children with Hodgkin lymphoma 

A child's cancer diagnosis can bring with it feelings of uncertainty for parents and other family members. Suddenly, you're thrust into a fast-paced world of change, worry, fear, and concern. You'll need to make treatment decisions while taking the time to comfort your child¾and at the same time, trying to cope with your own emotions.

Children and adolescents with Hodgkin lymphoma have special needs for their treatment and care. Usually, specialized cancer centers for children and adolescents are best equipped to address these needs. These centers offer the advantage of having doctors called “pediatric oncologists,” who specialize in treating children with cancer and therefore understand their unique needs. 

Learn how to find a blood cancer specialist or treatment center.  

It is important for parents of children diagnosed with Hodgkin lymphoma to talk to members of the oncology team about the:  

• Specific subtype of the disease
• Stage of the disease
• Risk of treatment-related fertility issues
• Other risk factors

Doctors use all of this information about the patient’s disease to determine the most effective treatment approach. They can develop treatment plans that limit the amount of therapy required to bring about remission. It is important for parents to discuss their children’s planned therapy with members of the oncology team to learn about the treatment schedule and the drugs that will be used, as well as their potential side effects and long-term effects. 

Usually, one or more of the following treatment approaches are used for children with Hodgkin lymphoma: 

• Chemotherapy
• Image-guided radiation therapy (IGRT)
• Targeted therapy
• Immunotherapy (monoclonal antibodies and checkpoint inhibitors)
• Surgery (if a mass can be completely removed)
• High-dose chemotherapy with stem cell transplantation

Learn more about the impact Hodgkin lymphoma treatment may have on your child’s fertility and reproductive health. 

Drug Combinations  
Children and adolescents are treated with dose-intensive regimens that are adjusted based on monitoring of early treatment response.  

The following is a list of just some of the many drug combinations used:  

• ABVE : Doxorubicin (Adriamycin®), bleomycin (Blenoxane®), vincristine, etoposide (Etopophos®)
• ABVE-PC: Doxorubicin (Adriamycin®), bleomycin (Blenoxane®), vincristine, etoposide (Etopophos®), prednisone, cyclophosphamide
• ABVD: Doxorubicin (Adriamycin®), bleomycin (Blenoxane®), vincristine, etoposide (Etopophos®), prednisone, cyclophosphamide
• BEACOPP: bleomycin (Blenoxane®), etoposide (Etopophos®), doxorubicin (Adriamycin®), cyclophosphamide, vincristine, procarbazine, prednisone
• Bv-AVE-PC: Brentuximab vedotin, doxorubicin (Adriamycin®), vincristine, etoposide (Etopophos®), prednisone, cyclophosphamide
• COPP/ABV : cyclophosphamide, vincristine, procarbazine, prednisone,  doxorubicin (Adriamycin®), bleomycin (Blenoxane®), vinblastine
• Escalated BEACOPP: Bleomycin (Blenoxane®), etoposide (Etopophos®), doxorubicin (Adriamycin®), cyclophosphamide, vincristine, procarbazine, prednisone
• OEPA/COPDAC (for males): Vincristine, etoposide (Etopophos®), prednisone, doxorubicin (Adriamycin®), followed by cyclophosphamide, vincristine, prednisone, dacarbazine
• OPPA/COP (for females): Vincristine, procarbazine, prednisone, doxorubicin (Adriamycin®), followed by cyclophosphamide, vincristine, procarbazine, prednisone 

For information about the drugs listed on this page, visit our cancer drug listing.   

Clinical trials 

A clinical trial may be an option when it comes to finding the right treatment for your child's cancer. Your child may have access to new or improved therapies under study and not yet on the market. Discuss with your child's doctor the possibility of taking part in a clinical trial, where treatment is administered in a safe, closely monitored environment. 

Advances in treating childhood Hodgkin lymphoma, which have improved the cure rate and quality of life for survivors, are due largely to the research of pediatric cooperative groups.  

The focus of ongoing research and clinical trials is to: 

• Further improve the cure rate, especially for children with advanced HL
• Improve quality of life
• Minimize the risk of long-term and late effects associated with treatment (for example, infertility, impaired cardiac function, and secondary cancers)
• Improve the overall survival rate 

Learn more about clinical trials. 

Long-term and late effects of treatment 

Some side effects of cancer treatment, such as fatigue, can linger for months or years after therapy. Most childhood survivors of lymphoma don't develop significant long-term or late effects of treatment. However, for some patients, the effects can be severe. Some medical conditions, like heart disease and other cancers, may not appear until years after treatment ends. Long-term and late effects can affect your child's physical, mental, and cognitive (brain function) health. 

Long-term and late effects of chemotherapy 

Children treated for lymphoma may be at increased risk for: 

• Fatigue 
• Cardiovascular (heart) disease 
• Hypothyroidism
• Fertility issues  

Some long-term and late effects become evident with puberty, growth, and the normal aging process. Early intervention and healthy lifestyle practices (not smoking, good nutrition, exercise, regular screenings, and follow-up) may have a positive effect on the occurrence and/or severity of long-term and late effects. 

Long-term and late effects of radiation therapy  

Children who receive radiation therapy to the chest are at an increased risk of breast cancer later in life. Patients who received radiation therapy to the chest (mediastinal) area should: 

• Perform monthly self-breast exams
• Have an annual clinical breast exam performed by a healthcare provider at least once a year until age 25 and then every 6 months after
• Have a yearly mammogram starting at age 25 or 8 years after treatment (whichever comes last) 

Children who've undergone chest radiation therapy should have baseline testing for heart function. This should be followed by testing every three to five years after treatment—or more regularly if any abnormalities are found. 

Learn more about the long-term and late effects of blood cancer treatment in children.  

Follow-up care 

Your child should visit their pediatrician or doctor at least once a year for a complete physical exam and any additional needed tests. Your child's oncologist should also regularly examine your child. 

Regular doctor visits are encouraged to: 

• Enable doctors to assess the full effect of therapy
• Detect and treat disease recurrence
• Identify and manage long-term and late effects of treatment

Find more information about follow-up care, including what to expect, long-term and late effects of treatment, survivorship clinics, and other resources, such as The National Comprehensive Cancer Network (NCCN) treatment guidelines. 

Survivorship and special healthcare needs 

After treatment, most children can expect to have full and productive lives. Many survivors return to school, attend college, enter the workforce, marry, and become parents. 

You may want to consider a survivorship program for your child that focuses on life after cancer. Many comprehensive cancer centers around the country offer these programs. 

Survivorship care plan 

Generally, “survivorship” refers to the health and well-being of a person after cancer treatment. Your child’s oncologist will help create a survivorship care plan for your child to guide follow-up care. Share the survivorship care plan with any healthcare providers your child sees. Learn more about survivorship care plans. 

Our Survivorship Workbook allows you to collect all the important information you and your child needs throughout diagnosis, treatment, follow-up care, and long-term management of a blood cancer.