Hodgkin lymphoma in children and adolescents: improving the therapeutic index

Abstract

Hodgkin lymphoma (HL) is a highly curable form of childhood cancer, with estimated 5 year survival rates exceeding 98%. However, the establishment of a "standard of care" approach to its management is complicated by the recognition that long-term overall survival declines in part from delayed effects of therapy and that there continue to be subgroups of patients at risk for relapse for which prognostic criteria cannot adequately define. This challenge has resulted in the development of various strategies aimed at identifying the optimal balance between maintaining overall survival and avoidance of long-term morbidity of therapy, often representing strategies quite different from those used for adults with HL. More precise risk stratification and methods for assessing the chemosensitivity of HL through imaging studies and biomarkers are in evolution. Recent advances in the understanding of the biology of HL have led to the introduction of targeted therapies in both the frontline and relapsed settings. However, significant barriers exist in the development of new combination therapies, necessitating collaborative studies across pediatric HL research consortia and in conjunction with adult groups for the adolescent and young adult (AYA) population with HL.

T-cell/histiocyte-rich large B-cell lymphoma in a child: A case report and review of literature

“…However, the pediatric population tend to have a better prognosis upon diagnosis and respond better with therapy compared to adults[ 3 ]. Misdiagnosing a patient with Hodgkin lymphoma (one of the treatable childhood cancers with a 5-year survival rate above 98%[ 22 ]) and missing THRLBCL would negatively impact patient’s survivability and treatment outcome as the stage of the cancer advances without appropriate treatment.…”

Closing the survivorship gap in children and adolescents with Hodgkin lymphoma

“…The delivery of dose dense therapy in Children's Oncology Group (COG) regimens is facilitated by supportive care including granulocyte colony‐stimulating factor (GCSF) and accepted myelosuppression in paediatric settings. These studies demonstrate anti‐lymphoma efficacy with lower cumulative doses of alkylating agents and anthracyclines (Table ) than are customary with adult treatment regimens (Kelly, ). Furthermore, risk‐based response adapted approaches, facilitated by interim imaging in recent paediatric trials have decreased RT delivery (Friedman et al , ; Keller et al , ; Kelly et al , ).…”

“…Therapy for children with lymphocyte‐predominant histology HL has diverged from therapy for NS and MC disease, with the recognition that this is a biologically different disease (Appel et al , ; Marks et al , ). A comprehensive review in 2015 summarized contemporary paediatric treatment approaches for de novo HL (Kelly, ). Five‐year DFS in paediatric HL ranged from 79·8% to 97% for low risk HL (Landman‐Parker et al , ; Mauz‐Korholz et al , ; Metzger et al , ; Tebbi et al , ; Wolden et al , ; Keller et al , ) to 77 to 90 % for high risk disease (Schwartz et al , ; Mauz‐Korholz et al , ; Kelly et al , ; Wolden et al , ; Friedman et al , ; Kelly et al , ) in completed trials.…”

Pathway‐focused gene expression profiles and immunohistochemistry detection identify contrasting association of caspase 3 (CASP3) expression with prognosis in pediatric classical Hodgkin lymphoma

“…Latent Epstein‐Barr virus (EBV) infection was determined by in situ hybridization (ISH) with probes for EBV‐encoded EBERs RNAs. All patients were treated with adriamycin‐based standard pediatric protocols (50% HD‐90, 45% ABVD, and 5% others protocols) . This study was approved by the INCA Ethics Committee (Protocols 37/05 and 56999916.5.0000.5274).…”