Late and Long-Term Effects of Treatment for Non-Hodgkin Lymphoma in Children

Because of major advances in treatment, most children treated for non-Hodgkin lymphoma (NHL) now live well into adulthood, so there are more concerns about their health as they get older.

Just as the treatment of childhood lymphoma requires a very specialized approach, so does follow-up and monitoring for late effects of treatment. Careful follow-up after treatment is very important, as some side effects might not show up until many years after treatment. The earlier any problems are recognized, the more likely it is they can be treated effectively.

Childhood lymphoma survivors are at risk, to some degree, for several possible late effects from their cancer treatment. This risk depends on a number of factors, such as the type of lymphoma, the type and doses of treatments, and the child's age when getting treatment. It’s important to discuss what these possible effects might be with your child’s medical team so you know what to watch for and report to the doctor.

Late effects of treatment might include:

• Heart or lung problems after getting certain chemotherapy drugs or radiation therapy to the chest
• Slowed or limited growth and development (especially after a stem cell transplant)
• Bone damage or thinning of bones (osteoporosis)
• Changes in sexual development and ability to have children (see below)
• Learning difficulties and changes in intellectual function
• Development of second cancers, such as leukemia, later in life. This are not common, but it can happen. 

Cancer treatment might affect sexual development and the ability to have children later in life. Talk with your child’s cancer care team about the risk of treatment affecting fertility, and ask if there are ways to preserve fertility. For more information, see Preserving Fertility in Children and Teens With Cancer.

There may be other complications from treatment, as well. Your child’s doctor should carefully go over any possible problems with you before your child starts treatment.

Along with physical side effects, survivors of childhood cancer may have emotional or psychological issues. They also may have some problems functioning normally and with school work. Support and encouragement can often help with these issues. Doctors and other members of the health care team can often recommend special support programs and services to help children after cancer treatment.

Long-term follow-up guidelines

It's very important to discuss possible long-term complications with your child’s health care team, and to make sure there is a plan in place to watch for these problems and treat them, if needed.

To help increase awareness of late effects and improve follow-up care for childhood cancer survivors throughout their lives, the Children’s Oncology Group (COG, the major group of doctors who treat childhood cancer in the US) has developed long-term follow-up guidelines for survivors of childhood cancers. These guidelines are used to help create a child's survivorship care plan. They can also can help you know what to watch for, what types of screening tests should be done, and how late effects may be treated.

To learn more, ask your child’s doctors about the COG survivor guidelines. You can also download them for free at the COG website: www.survivorshipguidelines.org. The guidelines are written for health care professionals but patient versions of some of the guidelines are available (as “Health Links”) on the site as well.

For more about some of the possible long-term effects of treatment, see Late Effects of Childhood Cancer Treatment.