Pediatric Leukemia and Lymphoma Diagnosis and Treatment

A portrait of Dr. Bill Chang, director of our leukemia and lymphoma program.
Dr. Bill Chang is the director of Doernbecher’s leukemia and lymphoma program. He cares for children and teens with all types of blood cancers. Dr. Chang also leads a research lab that focuses on new targeted therapies for blood cancers.

OHSU Doernbecher Children’s Hospital is a national leader in caring for children with leukemia and lymphoma. We are on the front edge of research, helping pioneer next-generation therapies.

Patients benefit from:

  • Doctors and other specialists who are national experts in childhood blood cancers.
  • The most advanced treatments. Doernbecher was the first hospital in the Pacific Northwest to offer CAR T-cell therapy for a type of childhood leukemia. We are the only Oregon hospital to offer this treatment for children.
  • A team of specialists — from specialized nurses to child life professionals to social workers — to support your child and family throughout treatment.
  • Doctors, nurses and other care givers who bring you and your family into every decision.
  • An immunotherapy and cell transplant program with one of the nation’s most experienced teams.
  • Access to clinical trials to try treatments that are not widely available through the Children’s Oncology Group (COG). COG is a member of the National Cancer Institute’s National Clinical Trials Network (NCTN) and the Theraputic Advances in Childhood Leukemia & Lymphoma Consortium (TACL).

Team-based care

Our providers work together, combining their expertise for each child. We meet very frequently to discuss cases and look at your child’s leukemia cells under a microscope.

Our team includes:

  • Doctors who are national experts in many blood cancer treatments, including bone marrow/stem cell transplants, targeted therapy and immunotherapy.
  • Nurses who are specially-trained to give chemotherapy and other treatments
  • Radiation oncologists (doctors who provide radiation therapy)
  • Surgeons
  • Nurse practitioners
  • Social workers
  • Researchers at the forefront of discovery in blood cell biology and the diagnosis of blood diseases.

Diagnosis

Our team uses these tools to diagnose leukemia and lymphoma in children.

These tests measure cells and chemicals in your child’s blood to find anything abnormal. OHSU hematopathologists (experts who diagnose blood diseases) are some of the most experienced in the nation. They help us match treatments to your child’s specific cancer type.

Bone marrow tests can help diagnose leukemia. They are seldom used to diagnose lymphoma but might help us see if it has spread.

We might do one of two tests — a bone marrow aspiration or a bone marrow biopsy. Both involve inserting a hollow needle into one of your child’s bones, often a hip bone, to collect a sample. An anesthesiologist will put your child to sleep to prevent pain.

The test takes less than 30 minutes. We send the sample to our lab, and expert hematopathologists examine it to make a diagnosis.

A drawing of a doctor using a bone marrow needle to collect a sample from the back of a child’s hip bone.
During a bone marrow aspiration or a bone marrow biopsy, your child’s doctor will collect a sample to look for signs of leukemia.

The doctor inserts a small, hollow needle between spinal bones to withdraw liquid called cerebrospinal fluid, or CSF.

Tests on CSF can detect leukemia cells.

An anesthesiologist will put your child to sleep for this test.

We use imaging tests to see whether lymphoma has spread or how well treatment is working. We seldom use imaging tests for leukemia.

  • Chest X-rays can detect enlarged lymph nodes in the chest.
  • CT (computed tomography) scans make detailed images of the body, and can find enlarged lymph nodes or tumors.
  • Ultrasound may be used to see lymph nodes just under the skin or in the belly.
  • MRI (magnetic resonance imaging) scans use magnets and radio waves to create detailed images of the body.
  • PET (positron emission tomography) scans use a safe, low-level radioactive substance (tracer) and a special camera. The tracer is injected into your child’s bloodstream to make cancer cells easier to see. The scan gives us information about enlarged lymph nodes. It can show how your child is responding to treatment.
An illustration of a boy lying down getting a PET Scan.
Cancer cells are more visible in a PET scan. A sugary substance called a tracer is injected into the bloodstream, and cancer cells consume more of it than normal cells do. This makes them show up brighter in the scan.

In a biopsy, doctors collect a tissue sample to send to a lab for analysis. Children with lymphoma or leukemia may have one of these common biopsy types.

  • Surgical biopsy: A surgeon makes an incision to remove a lymph node or tissue from a possible tumor.
  • Needle biopsy: We use small, hollow needles to remove tiny pieces of tissue from a lymph node or tumor.
  • CT-guided biopsy: We use a CT scan to guide a needle biopsy. This is used when a lymph node or tumor is deep in the body.

Before a biopsy, an anesthesiologist will give your child medication to prevent pain.

Our specialists view the tissue under a microscope. We may do other tests to look for cancer, learn more about the type of cancer, and decide how to treat it.

Pediatric leukemia treatment

We offer the best known treatment options for leukemia, including the latest advances in targeted therapy and immunotherapy.

Your child’s treatment plan will be tailored to their needs. We seek parents’ input on everything, including treatments and side effects. We’ll listen to your concerns, answer any questions and help you prepare for treatment.

We’ll also get to know your child — what grade they’re in, what they like to do, what hobbies they have — and introduce you to a cancer social worker. Your family’s social worker is part of the team that supports you throughout treatment and beyond.

Children who might have leukemia may also have other health concerns that need immediate care. These conditions may include severe bleeding, infections and circulatory issues.

We’ll check for:

  • A shortage of normal white blood cells, which can lead to serious infections.
  • Low levels of the substances that help blood clot normally.
  • A lack of red blood cells, which can lower oxygen levels and strain the heart.

If your child has any of these conditions, we will treat them before beginning cancer treatment. We may give your child antibiotics, IV fluids and blood transfusions.

Chemotherapy is the main treatment for leukemia. It is medications taken as a pill or given through an IV. Chemotherapy can also be given through a long, thin tube called a catheter that is placed in a large blood vessel in your child’s chest. Your child will be asleep under anesthesia when the catheter is placed.

We will tailor chemotherapy to your child’s leukemia type. For example, acute myeloid leukemia (AML) responds best to higher doses over a shorter period, often less than a year. Acute lymphoblastic leukemia (ALL) is usually treated with lower doses over several years.

Chemotherapy kills cancer cells throughout the body. It also can kill healthy cells, leading to side effects such as hair loss, appetite loss, diarrhea, nausea, and increased risk of infection.

We strive to avoid possible long-term side effects and to limit more immediate side effects. “Supportive care” medications help reduce these side effects.

Your child’s doctor might recommend a bone marrow/stem cell transplant. In this therapy, stem cells are given to your child in an IV. The cells collect in bone marrow, where they begin making healthy blood cells.

The therapy requires close monitoring for several weeks because preparing the body to accept the cells weakens the immune system.

At Doernbecher, our pediatric bone marrow/stem cell transplant program is among the best in the U.S. OHSU’s transplant team has done more than 4,500 transplants, including more than 700 in children.

Everyone on the team is trained in the unique needs of transplant patients. The team is part of the Knight Cancer Institute, with the expertise of many doctors and researchers.

Targeted therapies are medications designed to attach to and block a specific type of leukemia or lymphoma cell without attaching to normal cells. These medications don’t kill healthy cells like chemotherapy does, so there are fewer side effects.

Targeted therapy is a growing form of treatment, with many recent advances. Pioneering research by OHSU’s Dr. Brian Druker led to a breakthrough medication for chronic myeloid leukemia.

People with CML were once likely to die of the disease. Imatinib, a daily pill, turned it into a manageable condition, saving tens of thousands of lives.

Cell therapy can help your child’s immune system recognize and kill cancer cells.

OHSU is a leader in immunotherapies, including helping develop one type of CAR T-cell therapy. This therapy is used to treat B-cell precursor ALL (acute lymphoblastic leukemia) in children and young adults.

Doernbecher is the only hospital in Oregon able to provide this complex therapy for children.

Learn more about:

Surgery is rarely used in leukemia treatment except for placing a port for chemotherapy. But your child’s doctor may use surgery for lymph node biopsies.

Your child’s surgeon may place a small device called a port in your child’s chest. It connects to a large blood vessel and lets us give medication or do blood tests without needing a needle or IV at each visit.

Pediatric lymphoma treatment

Doernbecher offers the latest therapies for pediatric lymphoma. Our team will work closely with your family to develop the best plan for your child.

As with leukemia, chemotherapy is the main treatment for childhood lymphoma. The combination of medication varies depending on the lymphoma type.

Chemotherapy kills cancer cells throughout your child’s body. It also can kill healthy cells, causing side effects such as hair loss, nausea, loss of appetite, diarrhea and increased risk of infection. Our team strives to limit both short- and long-term side effects.

As with leukemia, scientists have developed medicines that can target lymphoma cells at the molecular level. One type of targeted therapy/immunotherapy is monoclonal antibody therapy. Antibodies are proteins that help your child’s immune system remove foreign substances from the body.

Monoclonal antibody therapy uses antibodies made in a lab from a specific immune system cell.  These antibodies can target and kill cancer cells.

Radiation therapy uses high-energy beams, like X-rays, to kill cancer cells. Most often these rays are aimed from outside the body (external beam radiation).

Radiation might be combined with chemotherapy or used on its own. It is used more often in Hodgkin lymphoma.

Radiation treatment lasts only a few minutes, but you should plan for longer. Your child’s doctor will take time before treatment to make sure radiation beams are aimed precisely to destroy lymphoma cells.

Surgery is seldom used to remove lymphoma. It is sometimes used for an early stage of a non-Hodgkin lymphoma called Burkitt lymphoma. In this case, your child’s surgeon might remove a tumor before chemotherapy begins.

Surgery also might be used for a biopsy or to place a small device called a port in your child’s chest. It’s connected to a large blood vessel and lets us give medications or do blood work without needing a needle or IV at each visit.

A bone marrow transplant is sometimes an option for kids with non-Hodgkin lymphoma if chemotherapy doesn’t help or if cancer returns after treatment.

Doernbecher’s pediatric bone marrow transplant program is ranked among the nation’s best. Our deeply experienced transplant team has done more than 4,500 transplants, including more than 700 in children.

Support services

When your child seeks care from Doernbecher, you benefit from the full menu of support services we offer patients and families.

Our services include:

  • Social workers who can help your family cope with cancer.
  • Help with the physical and emotional side effects of cancer care.
  • Programs to address the financial burden of cancer treatment.
  • Programs devoted to life after childhood cancer.

Read more about our cancer resources for patients and families.

For families

Call 503-346-0640 to:

  • Request an appointment.
  • Seek a second opinion.
  • Ask questions.

Find resources and support.

Locations

Parking is free for patients and their visitors.

Doernbecher Children’s Hospital
700 S.W. Campus Drive
Portland, OR 97239
Map and directions

Find other locations across Oregon and in southwest Washington.

Refer a patient

Pint-sized champion

Bennett was just 14 days old when he started intensive leukemia treatment at Doernbecher. After 10 months, he went home cancer-free.