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.

Hodgkin lymphoma in children, adolescents and young adults – a comparative study of clinical presentation and treatment outcome

“…Randomized clinical trials comparing outcome between pediatric and adult classical Hodgkin lymphoma (cHL) treatment strategies are lacking [4,5]. A few older retrospective analyses have indicated similar outcomes in adolescents and young adults treated with adult protocols independent of age at diagnosis [6,7].…”

Lymphomas in childhood

“…Klasik olarak MOPP (mustard alkaloidler, onkovin, prokarbazin, prednizon) ve ABVD (adriamisin, bleomisin, vinblastin, dakarbazin) tedavi protokollerinde kullanı-lan kemoterapötiklerdir (4) . Sağaltım sırasında büyüme çağındaki çocukların KT'nin ve RT'nin olumsuzluklarından koruması amaçlanmalıdır (13) . Hastalar dü-şük, orta ve yüksek risk gruplarına ayrılarak sağaltım kurgulanmaktadır (4,14) .…”

“…Erken ve geç dönem sorunlar görülebilir (4,13) . Boy kısalığı, kardiyak ve pulmoner işlevlerde bozulma, tiroid patolojileri, kısırlık, ikincil kanserler, yaşam kalitesinin ve psikososyal işlevlerin bozulması önemli sorunlardır (1,4,13,15,16) .…”

“…Erken ve geç dönem sorunlar görülebilir (4,13) . Boy kısalığı, kardiyak ve pulmoner işlevlerde bozulma, tiroid patolojileri, kısırlık, ikincil kanserler, yaşam kalitesinin ve psikososyal işlevlerin bozulması önemli sorunlardır (1,4,13,15,16) . Hastaların yaşam oranlarını azaltmadan bu karmaşalardan koruyacak sağaltım protokolleri geliş-tirilmesine çalışılmaktadır (6,13,15,17,18) .…”

Risk-Adapted, Combined-Modality Therapy for Unfavorable Pediatric Hodgkin Lymphom

“…Good treatment planning with evaluation of site and extent of disease is an essential component of patient management [1]. With increasing understanding of the unique pathology of HL and the identification of novel targeted agents, there is an opportunity to further refine the therapy in order to improve the therapeutic index to maximize cure and reduce late toxicities of therapy [2].…”