Should Adolescents and Young Adults With Hodgkin Lymphoma Be Treated as Children or Adults?

Abstract

Hodgkin lymphoma (HL) is one of the most common cancers in adolescents and young adults (AYA). Pediatric and adult therapeutic strategies diverge while sharing the common objective: maintaining optimal efficacy with less long-term toxicity. However, few studies have compared the outcome of AYA treated according to one or the other approach. Among the 148 patients aged 15 to 25 years, treated at Saint-Louis Hospital for newly diagnosed HL between 2012 and 2018, 71 were treated according to an adult protocol and 77 according to a pediatric one. The 5-year OS and PFS were respectively 100% and 85%, with no significant difference between treatment groups (85% in pediatric vs 86% in adult, p=0.7). Overall, the 5-year PFS was 100% for early favorable stages and 78% for advanced stages. A higher risk of short-term steroid and vincristine-related toxicities was observed in pediatric regimen, whereas a higher risk of late toxicities was expected in adult regimen, due to higher anthracyclines, procarbazine, bleomycin and radiotherapy exposure. These results confirm the excellent outcome of AYA patients with HL, whatever the treatment strategies. They justify a tailor-made therapeutic decision and highlight the importance of managing AYA patients in dedicated units with trained professionals.