Burkhardt Birgit, Lenz Georg
NHL-BFM Study Center and Department of Pediatric Hematology and Oncology, University Children's Hospital Münster, Münster, Germany.
Translational Oncology, Department of Medicine A, University Hospital Münster, Münster, Germany.
Hematol Oncol. 2015 Jun;33 Suppl 1:62-6. doi: 10.1002/hon.2219.
Is there anything that we can learn from each other regarding paediatric and adult non-Hodgkin Lymphoma (NHL) management? Do we treat the same patients? Are there differences in lymphoma biology in the different age groups? Are the procedures of decision making and the infrastructure comparable? Is the weighing of toxicity and outcome aspects in the benefit and risk assessments prior to treatment decisions comparable? Interestingly, the proportional distribution of the NHL subtypes and the spectrum of NHL occurring in children and adolescents differs significantly from that in adults. This observation might motivate biological studies aiming to elucidate the pathomechanisms of lymphomagenesis. Concerning NHL diagnosis and staging, the comparison of outcome data reported for paediatric and adult patient series is often impaired by the use of different staging systems. However, the impact of reference laboratories supporting correct subtyping and the advantages of population-based patient recruitment are experiences that might be transferable between paediatric and adult oncologists. Interestingly, the process of implementing new drugs into current treatment strategies and making these drugs available to patients varies substantially across patient's age groups. The far lower absolute number of patients, especially of relapsed patients, and the favorable outcome with current standard treatment may contribute to the marked differences in the kinetic of implementing new compounds comparing adult with paediatric NHL patients. Also, the basis for the conduction of cooperative clinical trials with pharmaceutical companies needs to be strengthened in paediatric clinical trial groups. In conclusion, both paediatric and adult oncologists benefit from the interdisciplinary discussion with each other, not only concerning results and experiences in clinical trials but also with respect to critical aspects of infrastructure.
在小儿和成人非霍奇金淋巴瘤（NHL）的管理方面，我们能从彼此身上学到什么吗？我们治疗的是同一类患者吗？不同年龄组的淋巴瘤生物学特性有差异吗？决策程序和基础设施具有可比性吗？在治疗决策前的获益和风险评估中，对毒性和预后方面的权衡具有可比性吗？有趣的是，儿童和青少年中NHL亚型的比例分布以及NHL的谱系与成人有显著不同。这一观察结果可能会推动旨在阐明淋巴瘤发生病理机制的生物学研究。关于NHL的诊断和分期，由于使用不同的分期系统，小儿和成人患者系列报道的预后数据比较常常受到影响。然而，支持正确亚型分类的参考实验室的作用以及基于人群招募患者的优势，这些经验可能在小儿和成人肿瘤学家之间相互借鉴。有趣的是，将新药纳入当前治疗策略并使患者能够使用这些药物的过程在不同年龄组的患者中差异很大。患者的绝对数量，尤其是复发患者的数量要低得多，以及当前标准治疗的良好预后，可能导致在引入新化合物的动态过程中，成人与小儿NHL患者之间存在显著差异。此外，小儿临床试验组与制药公司开展合作临床试验的基础需要加强。总之，小儿和成人肿瘤学家都能从彼此的跨学科讨论中受益，这不仅涉及临床试验的结果和经验，还涉及基础设施的关键方面。
