Lymphoma in Adolescents and Young Adults

doi:10.1053/j.seminoncol.2009.07.009

Seminars in Oncology

Volume 36, Issue 5, October 2009, Pages 381-418

https://doi.org/10.1053/j.seminoncol.2009.07.009 Get rights and content

Non-Hodgkin (NHL) and Hodgkin (HL) lymphomas are represented prominently in the adolescent and young adult (AYA) population. These diseases represent 11% of total cancer diagnoses in children, 4% in those 40 years of age and older, and 13% in AYA (aged 15–39 years). Although age-adjusted incidence rates of NHL increase with age, the more aggressive lymphomas are seen more commonly in the younger population with a transition to low-grade, indolent subtypes as the population ages. Burkitt lymphoma, diffuse large B-cell lymphoma, lymphoblastic lymphoma, and anaplastic large cell lymphoma make up the most common subtypes in the AYA population, although within the subgroup age 30–39 years, follicular lymphoma becomes more prominent. As a result, much of the armamentarium in the treatment of aggressive NHL and HL in adults is based on data from pediatric clinical trials. There are obvious limitations to this approach. It is vital that we gain a more thorough understanding of the biology and therapeutic responsiveness of NHL and HL in the AYA population. Thus, we must leverage the large prospective and retrospective trials that have been completed to date and redirect our approaches to cancer care in this unique population. We review the epidemiological data on NHL and HL from the Surveillance, Epidemiology and End Results registries as a cornerstone for a comparative analysis of therapeutic outcomes available in this population.

Section snippets

Epidemiology

As demonstrated in Figure 1, the risk of developing NHL increases with age. Clarke et al reported that, from 1973–1998, the incidence of NHL demonstrated an increase that was dependent on age at diagnosis, sex, and race.⁵ In our own independent review of the Surveillance, Epidemiology and End Results (SEER) registry, using nine US geographic areas from 1973–2004 (SEER 9), age-adjusted rates of NHL were calculated using the 2000 US standard population and analyzed with SEER*Stat software. From

Epidemiology

HL was first described in 1832, when Thomas Hodgkin presented postmortem findings on a series of patients, all of whom had massive enlargements of lymph nodes and spleen. It is one of the most common tumors in AYA, and represents approximately one third of lymphomas in children.169, 170 Among 15- to 29-year-olds, it accounts for 12% of cancers and is the most common hematologic malignancy. As is evident in Figure 13A, HL has a bimodal distribution, with incidence peaks in the 20- to 24-year age

Conclusion

Many improvements in our understanding of NHL and HL have occurred over the last several decades. Outcome improvements have mirrored our better understanding of the molecular, epidemiological, and genetic aspects of lymphomas. Unfortunately, our awareness of the unique aspects of lymphoma in the AYA age range lags behind our insights in children and older adults. In order to continue our course of improved mortality and morbidity across all age ranges, a comprehensive and coordinated approach

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: Supported by a Lance Armstrong Adolescent and Young Adult Project Grant.

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Impact of malignant disease on young adults IILymphoma in Adolescents and Young Adults

Section snippets

Epidemiology

Epidemiology

Conclusion

Curr Probl Pediatr Adolesc Health Care

Lancet

Blood

Mod Pathol

Blood

Blood

Am J Pathol

Blood

Cancer Genet Cytogenet

Biol Blood Marrow Transplant

Blood

Blood

Blood

Blood

Lancet

Blood

Pediatr Clin North Am

Blood

Blood

Ann Oncol

Blood

Blood

Blood

Am J Pathol

Blood

Blood

Blood

Immunity

Blood

Lancet

Blood

Cancer Statistics, 2009

CA Cancer J Clin

Non-Hodgkin's lymphomasApplication of the International Classification of Diseases for Oncology (ICD-O) to the Working Formulation

Cancer

Changing incidence of non-Hodgkin lymphomas in the United States

Cancer

The Non-Hodgkin's Lymphoma Classification Project

Blood

Immunologic characterization of human malignant lymphomas

Cancer

World Health Organization classification of neoplastic diseases of the hematopoietic and lymphoid tissues: report of the Clinical Advisory Committee meeting-Airlie House, Virginia, November 1997

J Clin Oncol

Who Classification of Tumours of Haematopoietic and Lymphoid Tissues. Vol 4

Fine-needle cytology and flow cytometry immunophenotyping and subclassification of non-Hodgkin lymphoma: a critical review of 307 cases with technical suggestions

Cancer

Utility of fine-needle aspiration as a diagnostic technique in lymphoma

J Clin Oncol

Diagnosis of lymphoma by image-guided needle biopsies: fine needle aspiration biopsy, core biopsy or both?

Acta Cytol

When to perform biopsies of enlarged peripheral lymph nodes in young patients

JAMA

End results of treating children with localized non-Hodgkin's lymphomas with a combined modality approach of lessened intensity

J Clin Oncol

Report of the Committee on Hodgkin's Disease Staging Classification

Cancer Res

A predictive model for aggressive non-Hodgkin's lymphomaThe International Non-Hodgkin's Lymphoma Prognostic Factors Project

N Engl J Med

Classification, staging and end results of treatment of childhood non-Hodgkin's lymphomas: dissimilarities from lymphomas in adults

Semin Oncol

Lymphomas and reticuloendothelial neoplasms

Non-Hodgkin's lymphoma in childhood

N Engl J Med

Diffuse large B-cell lymphoma. Vol 4

Impact of malignant disease on young adults II
Lymphoma in Adolescents and Young Adults