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Lymphoma Treatment Program

The Lymphoma Treatment Program at the Hyundai Cancer Institute at CHOC provides its patients with the non-Hodgkin lymphoma, Hodgkin lymphoma and recurrent lymphomas with the latest treatments available. Each treatment is customized to meet the specific needs of the patient while also balancing the social and emotional needs of the patient and family. Treatments are based on the type and stage of the lymphoma, as well as the most current national and international protocols and research available.

Our lymphoma team knows that a cancer diagnosis can be stressful and frightening. Our specialists are dedicated to providing the care, compassion and open communication patients and their families need. As part of their dedication, they make sure that all new patients are seen within 24 to 48 hours of being referred by their physician.

Dr. Kirov, Director of Lymphoma Treatment Program, with oncology patient

What We Treat

We treat all types of lymphoma:

Hodgkin lymphoma
Non-Hodgkin lymphoma (including diffuse large B-cell lymphoma, anaplastic large cell lymphoma, Burkitt lymphoma, primary mediastinal B-cell lymphoma, lymphoblastic lymphoma, grey zone lymphoma, peripheral T-cell lymphoma, NK-cell lymphoma, cutaneous T-cell lymphoma and other rare types of pediatric lymphomas)

Child life specialist with child in waiting room

Clinical Trials and Research

The experts at the Hyundai Cancer Institute at CHOC provide the very latest treatments and engage in innovative research furthering the advancement of treatment both for now and in the future.

Children’s cancers are very different than adult cancers and must be treated with specific pediatric cancer protocols. Our experience in exclusively treating children, adolescents and young adults (AYA) makes us the experts in the evaluation and treatment of all forms of common childhood and AYA cancers. We are dedicated to administering the very latest pediatric cancer treatment options. A majority of our treatment protocols come from the Children’s Oncology Group (COG), a national organization funded by the National Cancer Institute (NCI). We are also a member of several multi-institutional consortia that offer innovative treatments of pediatric lymphomas. Several pharma industries sponsored clinical trials for lymphomas are open at CHOC as well. In addition, we are offering individualized treatment approaches for patients with rare or unusual types of lymphomas or refractory disease.

Learn more about our ongoing research and the clinical trials available at the Cancer Institute.

We specialize in treating Hodgkin and non-Hodgkin Lymphoma

The Lymphoma Treatment Program consists of a multidisciplinary team of lymphoma experts and supportive pediatric services. The team is led by Ivan Kirov, M.D. who is a board-certified pediatric hematologist/oncologist, with an exceptional expertise in the area of pediatric lymphomas. He earned his medical degree from the Medical Academy in Sofia, Bulgaria in 1979. He did his residency and fellowship in Bulgaria where he went on to become an accomplished pediatric hematologist/oncologist for more than 12 years. In 1992, Dr. Kirov moved to the United States to become a visiting fellow in the bone marrow transplant program at the Johns Hopkins Hospital Oncology Center. He then went on to complete a residency in pediatrics at Westchester County Medical Center, New York Medical College (1992-1994) and postdoctoral fellowship in pediatric hematology/oncology at CHOC (1996-1999).

Ivan Kirov, M.D.

Learn more about our exceptional pediatric oncology-trained nurses, social workers, psychologists, nurse practitioners, child life specialists and case coordinators at the Cancer Institute.

Frequently Asked Questions About Lymphoma

We understand that a cancer diagnosis is overwhelming. To make the treatment process a little less confusing, the Lymphoma Treatment Team has put together this list of frequently asked questions and answers to make the process a little easier to discuss with family and friends. These questions should not replace the instructions and information provided by your child's treatment team.

What is lymphoma?

Lymphoma is a cancer of lymphocytes in which the cells divide and grow abnormally. The abnormal cells grow into a large collection of cells and when that grows big enough, it can be felt or seen on an x-ray or scans. When this occurs, a biopsy is done to determine the exact kind of lymphoma.

What are some of the different types of lymphoma?

There are two main types of lymphoma.

Hodgkin Lymphoma (HL) can affect children above 4 years of age, but is more frequently seen in adolescent and young adult patients. There are four main types of Hodgkin diseases:

Nodular Sclerosing (most common form)
Lymphocyte Predominant
Mixed Cellularity
Lymphocyte Depleted (least common form)

Non-Hodgkin lymphoma (NHL) is a term applied to number of different types of lymphatic cancers. The type of NHL will determine the treatment the patient will need. The most common types of pediatric non-Hodgkin lymphomas are:

Burkitt’s lymphoma is a non-Hodgkin lymphoma, Although it grows quickly, it is curable in a high percentage of people. Burkitt’s lymphoma grows predominantly in children and is also known as small non-cleaved cell lymphoma due to the distinct look of its cells under a microscope.
Lymphoblastic lymphoma is a high-grade non-Hodgkin lymphoma and is the most common lymphoma in children. Most of these lymphomas (80%) are T-cell lymphomas and the remainders are B-cell lymphomas. When a pathologist examines the lymphocytes under the microscope he or she can identify whether they are T cells or B cells. Lymphoblastic lymphomas occur predominantly in males and when found in adults typically occurs between 20 and 30 years of age. Most of the lymph nodes grow in the mediastimun (the front of the lungs).
Diffuse large B-cell lymphoma
Anaplastic large cell lymphoma

What are the symptoms of lymphoma?

The most common symptom is enlarged lymph nodes called lymphadenopathy. These enlarged lymph nodes may or may not be painful and can be found anywhere on the body. Other symptoms include:

Fatigue
Night sweats
Weight loss
Fever
Cough
Difficulty in breathing (shortness of breath)
Abdominal pain
Headaches
Visual disturbances

How is lymphoma diagnosed?

Lymphomas are diagnosed mostly by taking a small piece of the lymph node involved (biopsy) and sending it to the pathologist. The pathologist will then do special tests to determine the exact type of lymphoma. Other tests may include a bone marrow aspirate and/or biopsy that will show whether the lymphoma is involving the bone marrow. Patients with non-Hodgkin lymphoma will also need a spinal tap as a part of their diagnostic work-up.

How is lymphoma treated?

Hodgkin lymphoma is most commonly treated with a combination of chemotherapy and radiation treatment. Most recently, immunotherapy has been added to the treatment protocols. Chemotherapy involves the use of medications to treat cancer. The exact combination of chemotherapy and/or immunotherapy agents used depends upon the type and stage of the lymphoma. Radiation therapy is rarely used to treat non-Hodgkin lymphomas.

What are some of the side effects from treatment?

Some patients experience more side effects than others, but this does not mean that they are treated any differently. Chemotherapy can cause upset stomach, nausea, vomiting, hair loss, increased susceptibility to infections, low blood counts and may require blood and/or platelet transfusions. Red blood cell transfusions help to increase the amount of hemoglobin, the oxygen carrying component of blood. Platelets may also be needed if the platelet count is too low. Platelets prevent serious bleeding and help with blood clotting.

Are blood transfusions safe?

Donated blood products are vigorously screened. Any donor with a history of high-risk behaviors is not permitted to donate blood at any time. All donated blood is screened for HIV and hepatitis before it is released for transfusion to a recipient.

What should my child/family tell others about the diagnosis?

It is important to let others know that lymphoma is not contagious and that it is a cancer of a part of the immune system called the lymphatic system. Also, be assured that the risk for the patient’s siblings to develop lymphoma is minimal. It is also important to always check with those coming in contact with the patient to make sure they have not been sick or around anyone else who has been sick in an effort to keep the patient safe and healthy.

Are there any short-term or long-term effects of lymphoma?

As with any cancer, prognosis and long-term survival can vary greatly from child to child. Every child is unique, and treatment and prognosis are structured around the child. Our After Cancer Treatment Survivorship Program provides continuous follow-up care to cancer survivors which is essential for monitoring and treating the potential late effects of radiation and chemotherapy and for screening for secondary cancers, which rarely can occur in lymphoma survivors. New methods are continually being discovered to improve treatment and to decrease immediate and long-term side effects of therapy.