Prognostic Factors in Pediatric Classical Hodgkin Lymphoma: Concepts, Questions and Perspectives
Hodgkin´s Lymphoma (HL) is a disease typically affecting children and young adults, with more than 80% of patients being cured. The other side of high cure rate is that a fraction of patients will receive excessive antineoplastic radiochemotherapy resulting in the well-recognized late effects of HL treatment. Current clinical and radiological characteristics used for risk stratification in most treatment centers lead to mistaken stratification in almost one third of patients. Prognostic factors in HL are, mostly, crude direct measures of tumor burden and activity (stage, number of involved lymph nodes, bulky disease, B symptoms) or indirect surrogate measures of tumor burden and activity based on laboratory parameters (hemoglobin, s-albumin levels). Clinical characteristics at presentation, as well as protein immunoexpression and Epstein-Barr virus (EBV) association, have also been identified as prognostic factors in several studies. However, when sufficiently intensive treatment for advanced stages is employed, adverse prognostic factors tend to disappear. Thus, the identification of clinical and biological factors that allow discrimination of patients who may undergo a reduction in treatment intensity is a current goal to reduce late effects in HL.
Hodgkin lymphoma, childhood, adolescents, prognostic factors, EBV, microenvironment.