In a new review entitled “Hodgkin Lymphoma in Children and Adolescents: Improving the Therapeutic Index” a researcher at the Columbia University Medical Center, New York, highlighted the areas in pediatric research for Hodgkin lymphoma needing a better “standard of care” and more collaborative approach for the successful and quick development of efficient therapies. The review was published in the journal Blood.
Pediatric Hodgkin lymphoma is a cancer with one of the highest cure rates — estimates point to 5-year survival rates exceeding 98%. However, children’s long-term survival can decline due to delayed effects of therapy and inadequate prognostic criteria for subgroups of patients at risk of relapse. Therefore, developing strategies that not only maintain high rates of overall survival but also avoid long-term morbidity and mortality associated with directed therapies are a major focus in pediatric Hodgkin lymphoma research.
In this review, Kara M. Kelly, MD, Division of Pediatric Hematology/Oncology/Stem Cell Transplantation at Columbia, summarized the areas in Hodgkin lymphoma research hindering the development of novel pediatric therapies.
Recent data from clinical trials in children and adolescents with Hodgkin lymphoma suggest that pediatric treatments need different combinations of conventional chemotherapy, together with a continuous monitoring of patients’ early response to chemotherapy for subsequent therapeutic stratification. Pediatric Hodgkin lymphoma patients, upon diagnosis, are classified into risk groups according to the presence of prognostic factors. However, contrary to adults with Hodgkin lymphoma, there is no uniform system of prognostic stratification in pediatric Hodgkin lymphoma. This leads clinicians to use heterogeneous risk categories, rendering comparisons across studies challenging.
Dr. Kelly suggests that precision in risk stratification can be achieved by developing disease biomarkers, while the chemosensitivity of pediatric Hodgkin lymphoma patients may be determined by imaging studies. Moreover, understanding pediatric Hodgkin lymphoma biology, particularly its molecular pathogenesis, will allow researchers to develop new and tumor-targeted treatments in both frontline and relapse situations. However, this will require that international pediatric Hodgkin lymphoma research groups collaborate with those for the adolescent and young adult (AYA) population with Hodgkin lymphoma, and foster the development of new and more efficient therapies.