Six to Twelve Months Off Treatment for Non-Hodgkin Lymphoma (NHL)


By this time, most children will have normal blood counts, and by the end of the first year, their immune system has usually returned to normal.

Development of Fever or Illness

After 6 months off therapy, fevers and minor illnesses generally are managed as they would be for any child.  This may mean comfort care like bed rest and acetaminophen.  If your child’s fever is 101 degrees or more, or if your child appears very ill, you should visit the family doctor or pediatrician.

It will be hard not to worry when your child has a sore throat or headache, even though the most likely cause is a normal childhood illness.  For parents of children treated for cancer, it is not easy to keep “normal” childhood illnesses in perspective.  It is important to remember that all children get sick at times and recover with rest and comfort care.

Concerning Symptoms

Contact your health care provider at your treatment center if your child experiences:

  • Fever over 101 degrees for an extended period
  • Unexplained bruising
  • Repeated headaches and or vomiting in the early morning
  • Enlarging lymph glands  
  • Changes in mental status, including behaviors and level of alertness
  • Unexplained weakness in the arms or legs
  • Changes in bowel or urinary habits
  • Pain that wakes a child at night

If you have any questions or concerns, please don’t hesitate to contact your healthcare provider. They are there to answer your questions, provide advice and put your mind at ease.

Activity Restrictions

In general, children are encouraged to return to normal activities as soon as able, although some are left with lasting effects from the cancer or treatment and may not be able to do all they could do before treatment.  There may be some activity restrictions based on your child’s treatment.  For example, some healthcare providers discourage heavy weight lifting for patients who received high doses of chemotherapy medicines called “anthracyclines” (such as doxorubicin or daunorubicin).  Talk to your healthcare provider about specific limits for your child.

Immunizations

Chemotherapy used in conventional doses (not doses used for bone marrow or stem cell transplant) usually does not destroy the immunity gained from immunizations given before the cancer.  Your healthcare team will provide guidance on whether your child should have any immunizations repeated and may perform tests to decide if any boosters are needed.  Many children, especially young children, may have had their routine immunization schedule interrupted during treatment.  Most children are able to begin catching up any missed immunizations within 6 to 12 months of the end of treatment.  Some children who have had a bone marrow transplant should not have immunizations for even longer.  Your healthcare provider will talk with you about when it is safe for your child to have immunizations again. 

Coping with the Reminders of Diagnosis and End-of-Treatment

Anniversaries of the time of diagnosis or finishing treatment can be very emotional, and for many parents, create feelings of both sadness and joy.  In time, many parents find that they can reach a balance between being thankful that their child is free from cancer and the sadness over the inevitable losses the experience has brought.  Some families will have to come to terms with many such losses, particularly when children have lasting effects from the cancer treatment.

 

The First Month off Treatment
Two to Six Months off Treatment
One Year off Treatment and Beyond
Young Adults Transitioning to Adult-Focused Care
Long-Term Follow-Up Care 


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