Hodgkin lymphoma in adolescent and young adults: insights from an adult tertiary single-center cohort of 349 patients

Abstract

BackgroundAdolescent and young adults (AYA) represent one third of patients affected by Hodgkin lymphoma (HL). These patients are frequently treated either with pediatric or adult protocol depending on their physician background. This population has been understudied so far, in terms of HL characteristics and treatment-associated outcomes.AimWe aimed to extensively describe HL features in the AYA population including HL characteristics, progression-free (PFS) and overall survival (OS).MethodsFrom 1979 to 2013, consecutive patients with HL aged between 15 to 25 years and followed at Saint-Louis Hospital were prospectively enrolled. Survivals were estimated using the Kaplan-Meier method.Results349 patients were included and studied, with a median follow-up of 7 years. The majority of patients were treated with adult protocols (mainly ABVD and BEACOPP). They presented adverse clinical characteristics with a high proportion of stage III and IV according to Ann Arbor classification (45 %), a high rate of B symptoms (46 %) and extra-nodal involvement (36 %). Despite these pejorative clinical features, the prognosis remains good with a 10-year PFS and OS estimated at 81.0 % (95%CI [76.7-85.5]) and 90.7% (95%CI [87.2-94.4]), respectively. In multivariate analysis, stages III and IV according to Ann Arbor classification, mixed cellularity histology, elevated neutrophils and LDH above range were independently associated with a worse PFS. We identified a subgroup of 11 primary refractory patients with a particularly poor prognosis. The toxicity rate was low (7.4 %).ConclusionDespite their baseline pejorative features, AYA with HL have a good prognosis. Progresses are still needed in order to reduce toxicities. Primary refractory patients with a particularly poor prognosis should be detected early in order to quickly introduce new targeted therapies.

Clinicopathological features and EBV infection status of lymphoma in children and adolescents in South China: a retrospective study of 662 cases

“…The proportion of HL in children and adolescents in this study is 24.3% higher than that observed in western countries (11%-15%) [ 14 ]. Most HL patients showed lymphadenopathy which coordinates with other published data [ 15 ].…”

Comparison of Hodgkin’s Lymphoma in Children and Adolescents. A Twenty Year Experience with MH’96 and LH2004 AIEOP (Italian Association of Pediatric Hematology and Oncology) Protocols

“…Histologic subtype distributions present modifications according to age: nodular sclerosis was more frequent in adolescents than in children, while mixed cellularity and lymphocyte predominance was less frequent. This trend registered in our experience was also recorded by other recent researches [ 22 , 23 , 24 , 25 , 26 ]. A peculiarity that emerged in our study was the critical decrease in mixed cellularity frequency in children in the second protocol (22.6% vs. 9.8%).…”

“…Another peculiarity of our study, which lasted over an extended period, is that in the LH2004 protocol both children and adolescents were less frequently in low-stage disease, in contrast with other reports [ 18 , 22 , 25 ], while there was no difference between children and adolescents in stage distribution. Extra-nodal involvement increased, but only in adolescents enrolled in the LH2004 protocol.…”

Imaging features of extranodal involvement in paediatric Hodgkin lymphoma

“…The occurrence of liver involvement at presentation is 3%, according to literature [ 25 ], and in most of these cases the spleen is involved as well [ 12 ]. Hepatic involvement in lymphoma manifests usually as small or large focal lesions (Fig.…”