Late effects and frontline treatment selection for children with non-Hodgkin lymphoma

Survivors of childhood cancer comprise approximately 500,000 individuals among the United States population [1], a number anticipated to approach 580,000 by 2040 [2]. Childhood cancer survivors have been historically burdened by an increased risk of late morbidity and mortality relative to the general population [3,4], highlighting a need for ongoing research and heightened surveillance to inform the delivery of high-quality healthcare.

Non-Hodgkin lymphoma (NHL), the fourth most common malignancy in the pediatric and adolescent age range, has been the target of effective collaboratives, resulting in international trials, advancement of cure rates, and subsequently, emerging groups of long-term survivors [5]. The paradigm shift from a “one-size fits all” treatment strategy to histologically dependent regimens has facilitated risk-stratification and response-based approaches for some disease groups, most notably mature B-cell lymphoma, further advancing cure rates for even the highest risk individuals. As a result, nearly 45,000 individuals living in the United States are estimated to have survived NHL by 2040 [6]. As the number of NHL survivors continues to increase, providers will encounter a wide range of patients with diverse long-term complications [[7], [8], [9], [10], [11], [12]]. The following review summarizes the existing literature surrounding late effects unique to NHL survivors as well as those extrapolated from the broader childhood cancer survivor population.

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