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Hodgkin’s Lymphoma in Adolescents and Young Adults

Published Online: June 25th 2012 Oncology & Hematology Review (US), 2012;8(2):116-122 DOI: https://doi.org/10.17925/OHR.2012.08.2.116
Authors: Laura Rodriguez, Angela Punnett
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Abstract:
Overview

Adolescents 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.

Keywords

Hodgkin’s lymphoma, therapy, late effects, adolescents and young adults, second malignancies

Article:

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. The resulting delays in seeking appropriate medical care, delays in diagnosis, and subsequent compliance issues during treatment complicate medical management of cancer among AYAs.2–5 The most recent US Surveillance, Epidemiology, and End Results data indicate less survival improvement in AYAs with cancer compared with children and older adults.6

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 1.2.6–9 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.11,12 The 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.7–9,13,14 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 Outcomes
Studies focusing specifically on AYAs diagnosed with HL are scarce. Reviewing the literature, we found eight studies, and their main characteristics are summarized in Table 1. A UK study analyzed adolescents diagnosed with HL between 1970 and 1997 who received treatment with adult-type protocols.16 The OS at 5 and 20 years was 90% and 84% for stage I-IIA HL and 72% and 54% respectively for more advanced disease. However, the event-free survival (EFS) at five and 20 years was 59 % and 52 % in stage I–IIA disease, falling to 41 % and 31% in more advanced disease. The authors highlight that EFS is a more reliable measure of treatment efficacy than OS.

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Article Information:
Disclosure

The authors have no conflicts of interest to declare.

Correspondence

Angela Punnett, MD, Division of Haematology/Oncology, SickKids Hospital, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada. E: angela.punnett@sickkids.ca

Received

2012-08-22T00:00:00

References

  1. Bleyer A, Barr R, Hayes-Lattin B, et al., The distinctive biology of cancer in adolescents and young adults, Nat Rev Cancer, 2008;8(4):288–98.
  2. Butow P, Palmer S, Pai A, Goodenough B, et al., Review of adherence-related issues in adolescents and young adults with cancer, J Clin Oncol, 2010;28(32):4800–9.
  3. Burke ME, Albritton K, Marina N, Challenges in the recruitment of adolescents and young adults to cancer clinical trials, Cancer, 2007;110(11):2385–93.
  4. Zebrack B, Bleyer A, Albritton K, et al., Assessing the health care needs of adolescent and young adult cancer patients and survivors, Cancer, 2006;107(12):2915–23.
  5. Martin S, Ulrich C, Munsell M, et al., Delays in cancer diagnosis in underinsured young adults and older adolescents, Oncologist, 2007;12(7):816–24.
  6. Howlader N NA, Krapcho M, Neyman N, et al. (eds.), SEER Cancer Statistics Review, 1975–2008, Bethesda, MD: National Cancer Institute, 2011. Available at: https://seer.cancer.gov/ csr/1975_2008/ (accessed August 17, 2012).
  7. Foltz LM, Song KW, Connors JM, Hodgkin’s lymphoma in adolescents, J Clin Oncol, 2006;24(16):2520–6.
  8. Eichenauer DA, Bredenfeld H, Haverkamp H, et al., Hodgkin’s lymphoma in adolescents treated with adult protocols: a report from the German Hodgkin study group, J Clin Oncol, 2009;27(36):6079–85.
  9. Koumarianou AA, Xiros N, Papageorgiou E, et al., Survival improvement of young patients, aged 16-23, with Hodgkin lymphoma (HL) during the last three decades, Anticancer Res, 2007;27(2):1191–7.
  10. Alexander FE, Jarrett RF, Lawrence D, et al., Risk factors for Hodgkin’s disease by Epstein-Barr virus (EBV) status: prior infection by EBV and other agents, Br J Cancer, 2000;82(5):1117–21.
  11. Armstrong AA, Alexander FE, Cartwright R, et al., Epstein-Barr virus and Hodgkin’s disease: further evidence for the three disease hypothesis, Leukemia, 1998;12(8):1272–6.
  12. Gallagher A, Perry J, Freeland J, et al., Hodgkin lymphoma and Epstein-Barr virus (EBV): no evidence to support hit-and-run mechanism in cases classified as non-EBV-associated, Int J Cancer, 2003;104(5):624–30.
  13. National Cancer Institute, Childhood Hodgkin Lymphoma Treatment (PDQ®), Cellular Classification and Biologic Correlates. Available at: www.cancer.gov/cancertopics/ pdq/treatment/childhodgkins/HealthProfessional/page2 (accessed August 17, 2012).
  14. Muller J, Illes A, Molnar Z, et al., Adolescent hodgkin lymphoma: are treatment results more favorable with pediatric than with adult regimens? J Pediatr Hematol Oncol, 2011;33(2):e60–3.
  15. Diehl V, Hodgkin’s disease – from pathology specimen to cure. N Engl J Med, 2007;357(19):1968–71.

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