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Burkitt lymphoma: staging and response evaluation
1Department of Oncology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA. john.sandlund@stjude.org
Insights
Refinements in staging and response evaluation for pediatric Burkitt lymphoma (BL) have improved outcomes. Novel technologies like positron emission tomography (PET) and minimal residual disease (MRD) assessment require further study for optimal use in children with BL.
Area of Science:
- Pediatric Oncology
- Hematology
- Medical Imaging
Background:
- Treatment outcomes for pediatric Burkitt lymphoma (BL) have improved over 40 years due to advancements in staging and response evaluation.
- Current staging systems, like the Murphy system (1980), require refinement, especially for extranodal sites (skin, bone).
- Technological progress has significantly impacted disease detection and response assessment.
Purpose of the Study:
- To highlight the need for refining staging and response evaluation in pediatric Burkitt lymphoma.
- To emphasize the role of novel diagnostic technologies in improving assessment.
- To call for more clinical data on advanced imaging and MRD in pediatric non-Hodgkin lymphoma (NHL).
Main Methods:
- Review of historical and current staging systems for pediatric BL and NHL.
- Discussion of evolving response evaluation modalities from X-rays to PET and MRD.
- Identification of areas for improvement in staging and response assessment.
Main Results:
- Past staging systems (Ziegler/Magrath, Murphy) have evolved, but opportunities for refinement exist.
- Functional imaging (PET) and minimal residual disease (MRD) technology offer enhanced sensitivity for disease detection.
- Significant advancements in imaging technologies (CT, PET) have transformed response evaluation over decades.
Conclusions:
- Refined staging and response evaluation are crucial for improving pediatric BL treatment outcomes.
- Further clinical data is needed on PET and MRD for accurate response assessment in pediatric BL and other NHL subtypes.
- An international working group is actively refining staging and response evaluation for pediatric NHL.
Abstract:
The refinements in both the staging and response evaluation of children with Burkitt lymphoma (BL) have contributed to the improvements in treatment outcome observed over the past 40 years. Ziegler and Magrath designed a staging system in the 1970s for children with BL in equatorial Africa. Currently, the most widely used staging system around the world is that described by Murphy in 1980, which was developed for children with non-Hodgkin lymphoma (NHL) of any histology. There are opportunities for refinement in this system, particularly with respect to certain extra-nodal sites, such as skin and bone. The findings obtained at diagnosis with novel technologies (functional imaging [e.g., positron emission tomography [PET]] and minimal residual disease [MRD] technology), which are more sensitive with respect to disease detection than historic modalities, also need to be considered. Technological advances have also had impact on the assessment of response evaluation. Standard x-rays were routinely used in the 1960s; nuclear imaging became widely used in the 1970s; computerized axial tomography was incorporated in the 1980s; PET imaging was incorporated and, in many cases, has replaced gallium/bone scans since 2000; and MRD technology has been explored in some of the most recent clinical trials. There is clearly a need for more clinical data on the use of PET and MRD technology in the determination of response evaluation of children with BL as well as other histological subtypes of NHL. An international working group is currently addressing the refinement of both disease staging and response evaluation in children with NHL.