The treatment of pediatric lymphomas: paradigms to plagiarize?

The excellent results in pediatric lymphomas presented at the Sixth International Conference on Malignant Lymphoma in Lugano encompass several emerging themes and provide paradigms which it may be possible to extrapolate to at least some adult lymphomas. In pediatric Hodgkin's disease, there is mounting evidence that radiation adds nothing except toxicity to effective chemotherapy regimens, with the possible exception that patients with bulky disease, particularly in the mediastinum, may benefit from involved-field radiation. This is of particular importance in view of the recently recognized high rate of late-occurring second solid tumors and cardiac infarction, largely referable to radiotherapy. It is likely that there will be greater efforts to eliminate radiation from treatment protocols wherever possible. In pediatric non-Hodgkin's lymphomas, the intensive regimens used by several cooperative groups in Europe and the United States have resulted in very high event-free survival rates--90% in B-cell lymphomas, and only slightly lower in T-cell lymphomas. These results stand in striking contrast to those obtained in adults with the same diseases, except those treated with the same treatment protocols, who appear to have a similar prognosis. Finally, progress in the characterization of the molecular abnormalities and viral association of pediatric lymphomas is leading to new approaches to diagnosis and the detection of minimal residual disease, as well as to the development of targeted treatment approaches.