Better survival in children and adolescents with non-Hodgkin’s lymphoma

Stable incidence, improved survival and lower mortality are the results of the first population study in the Netherlands in children and adolescents under the age of 18 with non-Hodgkin’s lymphoma in the period 1990 – 2015. These are favorable results, according to Dr. Henrike Karim-Kos, epidemiologist and principal investigator at the Princess Máxima Center for Pediatric Oncology in Utrecht and senior investigator at IKNL. Karim-Kos is the initiator of the population study because epidemiological research has never been done in the Netherlands in incidence, survival and mortality among children (0-14 years) and adolescents (15-17 years) with non-Hodgkin.

The researchers analyzed data from 1001 children and adolescents. The data come from the Dutch Cancer Registry (NKR). These provide an almost complete picture of the number of children and adolescents who were diagnosed as non-Hodgkin in the period 1990-2015. Karim-Kos: ‘Therapists were therefore unable to provide parents with good information about the chance of their child’s survival based on Dutch data. There were US data, but they are not easily comparable with our Dutch figures. In the United States, children are often treated more intensively, and the composition of the population is also different. And we know that certain lymphomas are more common in certain populations. ‘

The study distinguishes between the four most common subtypes of non-Hodgkin’s: lymphoblastic lymphoma (LBL), Burkitt’s lymphoma (BL), diffuse large-cell B-cell lymphoma (DLBCL), and anaplastic large-cell lymphoma (ALCL). “This division into subgroups provides a lot of information,” says Karim-Kos. ‘BL, for example, is relatively more common in children up to 15 years of age. We see DLBCL more often in young people aged 15 and over. These subtypes also differ, among other things, in prognosis and treatments. Patients with LBL and BL were already doing quite well in the late 1990s compared to patients with DLBCL and ALCL. The improvements are also strongest for the last two groups. ‘

Less radiation treatment

The study shows that the 5-year survival rate in children and adolescents with non-Hodgkin’s disease in the early 1990s was about 70 percent. That percentage rises to almost 90 percent in the years 2010 – 2015. This improved survival has several causes, Karim-Kos assumes. ‘First, treatment protocols have changed since the late 1990s. Since then, less radiation therapy has been given to treat lymphomas because radiation therapy increases the risk of other tumors in the long run. In addition, since 2004, GPs have increasingly prescribed immunotherapy as a treatment intervention. And young people aged 15-17 are more often treated by the pediatric oncologist. We know that pediatric oncologists often treat more intensively than adult oncologists and that this leads to better results at the group level. ‘

‘It does not mean that adult oncologists are feeling worse,’ says Karim-Kos, ‘but we have seen a markedly better survival of 15-17-year-olds since then. Especially in adolescents with Burkitt’s lymphoma or diffuse large cell B-cell lymphoma. ‘ This better survival also leads to a lower mortality rate. Karim-Kos would also have liked to have seen the occurrence decrease over the years. ‘It has not happened, the incidence has been stable for years, with 38 children and adolescents being diagnosed non-Hodgkin each year. On the other hand, the incidence has not increased either. Apparently, the risk factors for non-Hodgkin’s have remained unchanged over the years. ‘

Zero measurement

Karim-Kos sees the population survey as a baseline measurement, as the first benchmark for the quality of treatment in the Netherlands for children and adolescents with non-Hodgkin’s disease. The study period, 1990 – 2015, was also not chosen at random. Then, in 2018, the Princess Máxima Center for Pediatric Oncology in Utrecht opened its doors. This led to further centralization in the diagnosis and treatment of lymphomas. “The assumption is that centralization leads to better care, but one wants to be safe. This is only possible if you have good comparison material. Hence this basic measurement. ‘

Whether centralization of care in the Princess Máxima Center leads to even better results for the treatment of non-Hodgkin’s lymphomas in children and adolescents must be demonstrated by follow-up research. ‘We need new NKR data for this, which will be collected in the coming years. Of course, we hope to be able to demonstrate that through further concentration of care we will be able to bring the survival rate from 90 to 100 percent. Whether it will work, you have to show. ‘

More information

Read the whole article:

  • Reedijk, AM, Beishuizen, A., Coebergh, JWW, Hoeben, BA, Kremer, LC, Hebeda, KM, … & Karim-Kos, HE (2022). Progress against non-Hodgkin’s lymphoma in children and adolescents in the Netherlands since 1990: Stable incidence, improved survival and lower mortality. European Journal of Cancer, 163, 140-151.

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