Childhood Hodgkin Lymphoma Treatment

Childhood Hodgkin lymphoma (HL) is a B-cell malignancy of Reed-Sternberg cells, with classical (nodular sclerosis, mixed cellularity, lymphocyte-rich, lymphocyte-depleted) and nodular lymphocyte-predominant subtypes. Peak incidence is in adolescence; classical HL is associated with EBV in 30 percent of pediatric cases.

Staging follows Ann Arbor with PET-CT replacing bone marrow biopsy in most cases. Risk groups (low/intermediate/high) are defined by stage, B symptoms, bulky disease, and number of involved nodal regions. Treatment is risk-adapted with regimens such as OEPA (vincristine, etoposide, prednisone, doxorubicin) and COPDAC (cyclophosphamide, vincristine, prednisone, dacarbazine) in EuroNet-PHL trials, with response-adapted involved-site radiotherapy reserved for inadequate early response.

Five-year overall survival exceeds 95 percent, with most relapses salvageable by intensified chemotherapy and autologous stem cell transplant. Late effects include secondary malignancies (breast, thyroid, lung), cardiac dysfunction, infertility, and thyroid hypofunction; minimizing alkylating agent exposure and reducing radiation field and dose are central goals of modern protocols. Brentuximab vedotin and PD-1 inhibitors are emerging in relapsed/refractory disease.