Abstract
Non-Hodgkin lymphoma (NHL) represents the fourth most common malignant disease among children and adolescents. Current disease classifications, including the most recent World Health Organization (WHO) classification and the International Consensus Classification (ICC), rely on a combination of clinical, epidemiological, histologic, immunophenotypic, and molecular data to define discrete clinicopathologic entities. There is growing evidence that children, adolescents, and young adults (CAYA) with B-cell NHL display unique clinical and epidemiologic characteristics. This may be explained by distinct age-related developmental plasticity, immune and haematopoietic repertoires, environmental exposures and social determinants of health, and germline or acquired genetic and molecular features, including those associated with inborn errors of immunity (IEI). Here, we discuss the unique clinical and biological characteristics of several distinct paediatric B-cell NHL types to indicate a path forward in classification of these CAYA NHL to optimally support multidisciplinary patient care and personalized treatment. We propose a potential "arising in CAYA" classification qualifier to denote the distinct clinicopathologic characteristics of B-cell NHLs that, otherwise, histologically and immunophenotypically resemble those arising in middle-aged and older adults. We also discuss how haemopathology diagnoses are evolving to incorporate the most current scientific knowledge into future classification systems of CAYA B-cell NHL.
Overview
- The study discusses the unique clinical and biological characteristics of certain types of non-Hodgkin lymphoma (NHL) that affect children, adolescents, and young adults (CAYA).
- The current classification systems for NHL, including the WHO and ICC, rely on a combination of clinical, epidemiological, histologic, immunophenotypic, and molecular data to define discrete clinicopathologic entities.
- The study proposes a new classification system, suggesting the use of a 'arising in CAYA' qualifier to denote distinct clinicopathologic characteristics of B-cell NHL that resemble those found in middle-aged and older adults.
Comparative Analysis & Findings
- The study highlights the unique clinical and biological characteristics of certain types of pediatric B-cell NHL, which may be explained by age-related developmental plasticity, immune and haematopoietic repertoires, environmental exposures, and social determinants of health, as well as germline or acquired genetic and molecular features.
- The findings suggest that incorporating current scientific knowledge into future classification systems of CAYA B-cell NHL may lead to more accurate and effective diagnoses and treatments.
- The study emphasizes the importance of multidisciplinary patient care and personalized treatment approaches for CAYA NHL, which may require different strategies than those used for middle-aged and older adults.
Implications and Future Directions
- The study's findings have significant implications for the diagnosis, classification, and treatment of CAYA NHL. A more accurate understanding of the unique characteristics of these diseases may lead to improved patient outcomes.
- Future research should focus on integrating current scientific knowledge into future classification systems and developing novel therapeutic strategies that take into account the distinct biology and clinical characteristics of CAYA NHL.
- The development of a more comprehensive understanding of CAYA NHL may also inform the development of prevention and early detection strategies, potentially reducing the burden of these diseases on children, adolescents, and young adults.