Should adolescents and young adults with Hodgkin lymphoma be treated as children or adults?

Hodgkin lymphoma (HL) is one of the most common cancers in adolescents and young adults (AYA). Paediatric and adult therapeutic strategies diverge while sharing the common objective: maintaining optimal efficacy with less long-term toxicity. However, few studies have compared the outcome of AYA treated according to one or the other approaches. Among the 148 patients aged 15-25 years, treated at Saint-Louis Hospital for newly diagnosed HL between 2012 and 2018, 71 were treated according to an adult protocol and 77 were treated according to a paediatric one. The 5-year overall survival (OS) and progression-free survival (PFS) were, respectively, 100% and 85%, with no significant difference between treatment groups (85% in paediatric vs. 86% in adult, p = 0.7). Overall, the 5-year PFS was 100% for early favourable stages and 78% for advanced stages. A higher risk of short-term steroid and vincristine-related toxicities was observed in paediatric regimen, whereas a higher risk of late toxicities was expected in adult regimen, due to higher anthracyclines, procarbazine, bleomycin and radiotherapy exposure. These results confirm the excellent outcome of AYA patients with HL, whatever the treatment strategies. They justify a tailor-made therapeutic decision and highlight the importance of managing AYA patients in dedicated units with trained professionals.