State of the art in the management of pediatric lymphoma

Pediatric lymphoma comprises 15-20% of the childhood cancer spectrum and represents the most curable end of the disease spectrum with current cure rates exceeding 90% for Hodgkin Lymphoma (HL) and over 80% for non-Hodgkin lymphoma (NHL). Whilst these cure rates were achieved over a decade ago, there has been a paradigm shift with current management regimens employing risk-stratified, response-adapted strategies, targeted therapies and increasingly immunotherapy. Ongoing efforts are focused on maintaining and further improving the high cure rates but at the same time limiting the price of cure in term of late effects that survivors have faced in the past decades especially for HL. The current review summarizes the recent advances in the management of pediatric lymphomas and the standard-of-care options for these conditions. Increasing use of PET-CT imaging for staging/risk-stratification and response assessment has played a big role in refinement of treatment strategies. Improved supportive care, reduction in indications, doses, and fields for radiation, and refinement of models of delivery have further contributed to limiting both acute and long-term toxicity. For HL, it is expected that chemo-radiotherapy is likely to get reduced and increasingly replaced by antibody-drug conjugates and immune-checkpoint inhibitors. For NHL, chemotherapy is expected to continue to play a major part along with monoclonal antibodies. Future strategies include increasing use of CAR-T cell therapy especially for NHL for relapsed/ refractory disease.