Pediatric Hodgkin lymphoma guidelines to help clinicians weigh treatment safety, efficacy
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Although Hodgkin lymphoma is a highly curable form of pediatric cancer, treatment often results in life-threatening or debilitating long-term adverse effects.
Given the number of available treatments, which can confer survival rates of 90% or higher, it is essential that clinicians consider the potential benefits and risks of various options for each patient.
To assist in that effort, the National Comprehensive Cancer Network has published new clinical practice guidelines for pediatric Hodgkin lymphoma.
The guidelines are especially needed during the COVID-19 pandemic, when travel restrictions prevent many patients from receiving treatment at academic medical centers, according to Jamie Flerlage, MD, MS, chair of the NCCN Guidelines Panel and a pediatric hematologist/oncologist at St. Jude Children’s Research Hospital.
“In the past, clinicians may have sent their patients for enrollment in a trial or to a center of expertise, but in the era of COVID-19, this might not be feasible,” Flerlage said in an interview with Healio. “This enables an individual provider, who does not need to be an expert in Hodgkin lymphoma, to have the latest, most efficacious regimens that minimize toxicity right in front of them.”
Flerlage spoke with Healio about the new guidance and how it can help clinicians choose the safest and most effective treatment for each child with Hodgkin lymphoma.
Question: What is the difference between pediatric Hodgkin lymphoma and adult disease?
Answer: There are a few differences in the subtype of lymphoma seen in children vs. adults. However, one of the main differences is simply the age of the patient and their risk for late effects from the chemotherapy they receive.
There are two peaks of patient ages in terms of Hodgkin lymphoma development. One is the teenage population, but the second population that’s commonly seen is much older — adults over age 65 years. For this age group, you have the ability to use drugs with 30-year toxicities, because the average person dies of natural causes by the age of 90 to 95 years. For children, it is necessary to choose a treatment regimen with decreasing intensity to minimize late effects.
Q: What prompted these guidelines?
A: I’m very grateful to the NCCN for moving forward with pediatric-specific guidelines for many different diseases. Guidelines for adults with Hodgkin lymphoma have been available for quite some time. One of the reasons these pediatric guidelines are super important is because they provide an evidence-based standard of care that clinicians can look back on to decide how to treat their patients, and specifically because Hodgkin lymphoma is a fairly rare pediatric disease. There’s not always an open clinical trial, which remains the standard of care. There are patients who don’t meet eligibility criteria and, as I mentioned, limits to travel due to COVID-19.
Q: How can these guidelines make treating this disease easier for clinicians who are unaccustomed to such cases?
A: Because of the curability, any provider can successfully treat Hodgkin lymphoma; it’s not intense therapy. It’s outpatient chemotherapy. What this gives them is the guidance of experts. It gives them the latest, evidence-based recommendations and the ability to weigh the risks and benefits throughout every phase, from diagnosis to the end of therapy.
These guidelines are important because these patients do survive. In each decade, we’ve been able to improve treatment for patients by essentially decreasing the intensity while keeping the outcome. So, if you treat a patient like you did 10 years ago, you won’t improve their cure rate, but you will absolutely increase the chance that they have late effects from their treatment. It’s important to stay up to date with this rare pediatric diagnosis, so you can not only cure your patient, but you cure them better.
For more information:
Jamie Flerlage, MD, MS, can be reached at 262 Danny Thomas Place, Memphis, TN 38105-3678; email: jamie.flerlage@stjude.org.
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NCCN. NCCN Guidelines and Clinical Resources. Available at: www.nccn.org/professionals/physician_gls/default.aspx#hodgkin. Accessed Oct. 20, 2020.
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