Hodgkin’s Lymphoma in Adolescents and Young Adults

Abstract

Adolescents and young adults (AYAs) are defined as those individuals between the ages of 15 and 39 years.1 AYAs with cancer are considered a vulnerable group, in large part due to psychosocial challenges in this population, including lack of insurance, low rates of clinical trial enrollment, issues pertaining to independence, and concerns about body image and fertility. Hodgkin's lymphoma (HL) is the most common cancer observed among AYAs. 6 There is a slight overall male predominance in this age group, with a male:female ratio of 1.2. [6][7][8][9] Prior history of infection with Epstein-Barr virus (EBV) has been associated with an increased risk of HL. 10 Among AYAs, however, molecular studies show that EBV is related to HL in only a minority of cases and that it is unlikely to play a major etiologic role. 11,12The most common histological subtype of HL among the adolescent and young adult (AYA) population is nodular sclerosing classical HL, occurring in 50-80 % of patients. [7][8][9]13,14 Over the past decades, the prognosis of HL has dramatically improved, 15 but the optimal treatment of AYA patients remains undefined and patients continue to be treated on many different regimens with either pediatric or adult protocols. We will examine available literature regarding outcomes for the AYA population and discuss the therapy-related long-term sequelae. Studies Examining Adolescent and Young Adult OutcomesStudies focusing specifically on AYAs diagnosed with HL are scarce. Reviewing the literature, we found eight studies, and their main characteristics are summarized in The results of these studies should be interpreted with caution, however, as historical practices no longer considered appropriate, such as staging laparotomy and splenectomy, were employed, as well as older chemotherapy and radiotherapy protocols. AbstractAdolescents and young adults (AYAs) are defined as those individuals between the ages of 15 and 39 years. Hodgkin's lymphoma (HL) is the most common cancer observed in AYAs. Over the last two decades, significant improvements in both survival from HL and the reduction of therapy-related late effects have resulted from the work of collaborative study groups in pediatric and adult domains. The adolescent and young adult (AYA) population falls between these domains. AYA patients are in a critical developmental transition, with significant psychosocial challenges that may impact on the outcome of the primary treatment as well as on the medical care and surveillance of long-term sequelae in survivors. This article will examine available literature regarding outcomes for HL in the AYA population, identifying issues unique to this group, therapeutic options, and specific concerns in follow-up. KeywordsHodgkin's lymphoma, therapy, late effects, adolescents and young adults, second malignancies Disclosure:The authors have no conflicts of interest to declare.

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

“…Adolescents aged 15–18 treated in the United Kingdom between 1969 and 1998 years showed OS rates lower than those of young adults, aged 20–25 [ 36 , 37 ]. It is not very easy to make a comparison with these studies, because of the old therapeutic regimens applied, together with old staging systems such as laparotomy and splenectomy, which are no longer considered appropriated [ 38 ]. In the period 1978–2003, a Greek study showed a progressive improvement in the OS of the 16–23-year-old AYAs treated with three consecutive adult chemotherapeutic regimens [ 39 ] and the more recent studies performed between 1979–2013 in Europe and Canada registered 5-year OS rates even higher than 90% [ 23 , 40 , 41 ].…”