At OncLive’s State of the Science Summit on Hematologic Malignancies, Dr. Lisa Roth, head of the Adolescent and Young Adult (AYA) Lymphoma Program at Weill Cornell Medicine and NewYork-Presbyterian, outlined some of the differences in treatment approaches between pediatric and adult patients with Hodgkin lymphoma (HL), a cancer commonly diagnosed in young adults in their twenties.
According to the National Institutes of Health (NIH), patients between 15 and 39 years of age are considered part of the AYA population.
“A patient in this age range can walk into a pediatric oncologist’s office or a medical oncologist’s office and receive vastly different treatment for the exact same diagnosis,” said Dr. Roth, highlighting the medical landscape’s current lack of and need for research in order to understand how to optimize care for AYA patients.
To compare and contrast the approaches, Dr. Roth broke down the components of the pediatric and adult treatment regimens for a standard case of Hodgkin lymphoma.
A HL patient treated under the pediatric regimen would typically receive four cycles of the chemotherapy drug combination doxorubicin hydrochloride, bleomycin, vincristine sulfate, etoposide phosphate, prednisone, and cyclophosphamide (ABVE-PC) over 12 weeks, as compared to the adult regimen of six cycles of chemotherapy drug combination doxorubicin hydrochloride, bleomycin, vinblastine sulfate, and dacarbazine (ABVD) over 24 weeks. About half of pediatric patients would receive radiation following ABVE-PC while very few adult patients would receive the same following ABVD.
Compared to its adult counterpart, the pediatric regimen has lower cumulative exposure to anthracycline, a drug class associated with cardiac toxicity that includes doxorubicin, as well as a lower dosage of bleomycin, a drug associated with pulmonary toxicity.
On the other hand, the adult ABVD regimen does not contain drugs etoposide or cyclophosphamide, both of which are associated with risk of secondary malignancies and infertility.
Dr. Roth explained that outcome improvements in adolescent and young adult patients are lagging behind those in both pediatric and adult populations – a disparity partially connected to the deficit of clinical and translational research focusing specifically on this age group. Other contributing factors may relate to differences in tumor biology in the AYA group that doctors do not yet fully understand, as well as the group’s tendency to delay physician consultation and to have limited healthcare access due to being under or uninsured.
Because the AYA population has such unique needs, they require a multidisciplinary team to guide them through each stage of their treatment process. The Weill Cornell Medicine/NewYork-Presbyterian Adolescent and Young Adult Lymphoma Program is composed of pediatric and medical oncologists, radiation oncologists, bone marrow transplant experts, fertility preservation specialists, and psychologists and social workers. The team also includes physicians who specialize in survivorship to allow for seamless care from treatment to beyond, which is specifically relevant for patients of this age range who are very likely to have many years of life to look forward to once cured of their disease.
WCM’s AYA Lymphoma Program is working hard to expand pediatric patients’ access to upcoming clinical trials and to develop trials specific to the AYA population.
For more from Dr. Roth on the intricacies of treating the AYA population, watch this video courtesy of OncLive:
Dr. Furman noted that current CLL therapies are effective, but they often lead to complications. CLL patients treated with standard chemotherapy drug combination fludarabine, cyclophosphamide, rituximab (FCR) are often prone to developing treatment resistance or Richter’s transformations (RT), in which their CLL transforms into a more aggressive diffuse large B-cell lymphoma (DLBCL). They may also succumb to infectious complications, adverse events, or secondary malignancies.
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