Childhood Leukemia and Lymphoma Treatment and Survival Rates

April 26, 2024 
This page was reviewed under our medical and editorial policy by Lindsey Murphy, M.D., Pediatric Hematologist-Oncologist and Assistant Professor in the Department of Pediatrics, City of Hope Duarte

Childhood leukemia and lymphoma treatment plans are tailored to each child. The treatments recommended are based on the cancer subtype, the stage or phase of the cancer, and the child’s overall health. 

The most common types of leukemia found in children are acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML). For these leukemias, treatment is often done in two to three phases over several years.

Two main types of lymphoma are found in children: Hodgkin lymphoma and non-Hodgkin lymphoma. Treatment for childhood lymphoma may be given for several months, and sometimes years.

These cancer types are further classified into subtypes and stages, helping patients and their care team understand the characteristics of the cells involved, how and where the cancer is growing, and which treatments it has been shown to respond to.

Many standard treatment options are available for pediatric blood cancers, with chemotherapy being the most commonly employed for both leukemias and lymphomas. Clinical trials may also be an option, which test newer therapies and standard therapies.

Survival rates for childhood leukemias and lymphomas have largely been improving over the past decades, and many children go on to live long, happy, productive lives after treatment.

Who Treats Childhood Leukemia and Lymphoma?

Treatment plans for childhood leukemia and lymphoma are developed by doctors with expertise in these cancers, which may include:

• Pediatric oncologists, who are experts in diagnosing and treating childhood cancers
• Pediatricians, who specialize in treating pediatric patients
• Hematologists, who are experts in diagnosing and treating disorders of the blood
• Oncologists, who stage and treat cancer
• Pediatric surgeons, who are experts in operating on children

Every step of the way, the care team discusses treatment considerations with all patients and their families, getting to know their preferences and understanding of their cancer and course of treatment.

Treatment for Childhood Leukemia and Lymphoma

A variety and combination of treatments may be used to treat childhood leukemias and lymphomas. A breakdown of the treatments that may be recommended and when they may be used are listed below.

Chemotherapy: This treatment uses drugs to destroy cancer cells or prevent them from dividing and multiplying. It may be given by mouth or injected into a vein or muscle. Sometimes, it is placed in the cerebrospinal fluid, an organ or a body cavity to target a specific region. Combination chemotherapy, which uses more than one cancer-fighting drug, is often used.

For ALL, combination chemotherapy is standard therapy, with high-risk children receiving more of these anticancer drugs. Chemotherapy may be placed in the space containing cerebrospinal fluid (intrathecal) if cancer has spread, or may spread, to the brain or spinal cord. For AML, chemotherapy may be given orally or injected into a vein or into the fluid-filled space surrounding the brain and spinal cord.

For Hodgkin lymphoma, the way chemotherapy is administered depends on a child’s risk — or stage of disease, size of the tumor and accompanying symptoms. For non-Hodgkin lymphoma, chemotherapy is also administered depending on the cancer type and stage. Intrathecal chemotherapy may be used.

Radiation therapy: This treatment damages the DNA in cancer cells and prevents them from growing by using high-energy X-rays or other radiation types that target the cancerous area. For these childhood conditions, radiation therapy comes from a machine outside of the body, also known as external radiation.

For ALL, external radiation therapy may be used if cancer has spread to the brain, spinal cord or testicles, or to prepare bone marrow for a stem cell transplant. For AML, external radiation therapy may be used to treat a myeloid sarcoma (a rare tumor in people with AML) that has not responded to chemotherapy.

For Hodgkin lymphoma, external radiation may be given, based on a child’s risk and chemotherapy regimen. It is administered only to the lymph nodes or other cancerous areas. For non-Hodgkin lymphoma, external radiation therapy may be used if the cancer has, or may, spread to the brain or spinal cord, or to treat cutaneous (skin) lymphoma.

Proton beam therapy uses protons to make radiation. This high-energy radiation therapy, sometimes used in treating Hodgkin lymphoma, may help limit damage to healthy tissue near a tumor.

Stem cell transplants: These procedures may be recommended to replace healthy, blood-forming cells after chemotherapy, since chemotherapy may destroy both cancerous and healthy cells. Healthy, immature blood cells are collected from the blood or bone marrow of the patient or a donor to support the transplant process. After the patient undergoes high-dose chemotherapy, the cells are infused into the patient. This process may be used to treat both lymphomas and leukemias.

Targeted therapy: This treatment uses drugs or other substances to attack cancer cells. For leukemias, this may include tyrosine kinase inhibitor (TKI) therapy. This therapy blocks the enzyme tyrosine kinase, which is involved in the overproduction of white blood cells. TKI therapy is not used to treat childhood lymphoma.

Monoclonal antibody therapy is another form of targeted therapy that may be used for both leukemias and lymphomas. Monoclonal antibodies are immune system proteins created in a laboratory. These antibodies attach to cancer cells or other cells that help cancer grow. Then, they destroy the cancer cells, block their growth and/or prevent them from spreading.

Protease inhibitors are another form of targeted therapy used in childhood lymphomas and some types of leukemia. These drugs pave the way for certain proteins to build up in cancer cells, which may cause them to die.

Many other targeted therapy options are being studied in clinical trials.

Immunotherapy: This leading-edge approach boosts and directs the patient’s own immune system to fight cancer. Different types of immunotherapy may be used to treat specific types of childhood blood cancers. For example, chimeric antigen receptor (CAR) T cell therapy, cyclosporine A and Epstein-Barr virus-specific cytotoxic T-lymphocytes (EBV-CTLs) may be used to treat some lymphomas. CAR T cell therapy may also be used to treat some types of leukemia.

Other drug therapies: Some medications have been developed specifically to treat certain types of blood cancers. For example, in AML, lenalidomide may be used to reduce the need for transfusions in patients with myelodysplastic syndromes. Arsenic trioxide (a chemotherapy drug) may be combined with tretinoin (a retinoid, similar to vitamin A) to destroy cancer cells or prevent them from growing or spreading in certain AML patients. For non-Hodgkin lymphoma, retinoids, steroids such as dexamethasone and prednisone, and antibiotics may be used as part of treatment.

Watchful waiting: This approach may be recommended for certain types of lymphoma and leukemia. In watchful waiting, a patient’s condition is closely monitored, and treatment does not begin unless signs or symptoms appear or change.

Surgery: Surgical procedures may be used for some lymphomas to remove as much of a tumor as possible. Surgery is not a treatment option for leukemia.

Phototherapy: This treatment uses an injected drug activated by a laser light to destroy cancer cells and may be used to treat a certain type of non-Hodgkin lymphoma called cutaneous T cell lymphoma (CTCL).

Childhood Leukemia Survival Rate

Survival rates are estimates of the percentage of patients who live five years or more after their diagnosis, compared to people without that cancer type. They are based on the experiences of children several years ago, and they do not account for recent advances in medicine. They are sometimes general and not specific to each disease subtype, nor do they account for unique patient factors.

For children with acute lymphocytic leukemia, the five-year relative survival rate is 92%, according to the American Society of Clinical Oncology (ASCO). The five-year relative survival rate of teens 15 to 19 years old with ALL is slightly lower at 77%, ASCO notes. 

For many children with acute leukemias, after this five-year mark is achieved, the cancer does not return. 

For acute myeloid leukemia, the five-year relative survival rate is 68% in children and teenagers, according to ASCO. 

Survival rates for rarer forms of leukemia in children are harder to assess, but like with many types of blood cancer, treatments are improving. The care team at City of Hope helps patients and families understand the prognosis for more common as well as rarer types of childhood leukemias.

Childhood Lymphoma Survival Rate

As with all prognostic information, five-year relative survival rates for childhood lymphomas are estimates based on the past, and sometimes relatively small numbers of patients. Patient factors and newer treatments impact survival and the response to treatment.

For children aged 14 and under with Hodgkin lymphoma, the five-year relative survival rate is 99%; and for teens 15 to 19 years old, the survival rate is 98%, according to ASCO.

For children under age 14 with non-Hodgkin lymphoma, the five-year relative survival rate is 91%; and for teens 15 to 19 years old, the survival rate is 89%, ASCO notes.