Pediatric Hodgkin Lymphoma: Past, Present and Future

Aaron Weiss; Michelle Neier; Richard A Drachtman


Pediatr Health. 2009;3(6):593-606. 

In This Article

Abstract and Introduction


The history of treatment of Hodgkin lymphoma in children and young adults has been one of increasing success, with the focus shifting in recent years from cure, regardless of the cost, to an increasing concern regarding late effects and other consequences of treatment. Ongoing protocols continue to explore the use of risk-based therapy, further delineating the ability to individualize therapy in an effort to decrease morbidity and mortality, while preserving excellent cure rates.


Prior to the differentiation of pediatric oncology as a separate specialty, children with Hodgkin lymphoma (HL) were treated as small adults, using adult paradigms. Radiotherapy alone was the initial mainstay of therapy, with cure possible in patients with limited disease. There was, however, a significant incidence of side effects due to irradiation, some of which were not appreciated until decades later, such as the increasing incidence of secondary malignancies in the radiation fields and cardiac disease, as well as relatively more acute effects, such as hypothyroidism and musculoskeletal growth arrest in the irradiated areas. The incorporation of systemic therapy enabled the degree of toxicity seen as a result of any one drug or modality to be reduced, and allowed patients to undergo clinical staging and to forgo staging laparatomy. While there are currently no identified biologic features unique to children, the current trend in the pediatric population is towards minimizing therapy while not sacrificing quality of life or ultimate survival.[1,2]


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