Revised International Pediatric Non-Hodgkin Lymphoma Staging System.
OBJECTIVE
Treatment and prognosis of pediatric non-Hodgkin lymphoma (NHL) have improved dramatically in the last 30 years. However, the St Jude NHL staging classification for pediatric NHL was developed more than 35 years ago. The most recent Lugano lymphoma staging classification focused on adult lymphoma. Furthermore, major limitations of the current pediatric NHL staging classification include lack of consideration of new distinct pediatric NHL histologic entities; absence of recognition of frequent skin, bone, kidney, ovarian, and other organ involvement; and lack of newer precise methods to detect bone marrow and CNS involvement, minimal disease quantification, and highly sensitive imaging technologies.


METHODS
An international multidisciplinary expert panel convened in Frankfurt, Germany, in 2009 at the Third International Childhood, Adolescent and Young Adult NHL Symposium to develop a revised international pediatric NHL staging system (IPNHLSS), addressing limitations of the current pediatric NHL staging system and creating a revised classification. Evidence-based disease distribution and behavior were reviewed from multiple pediatric cooperative group NHL studies.


RESULTS
A revised IPNHLSS was developed incorporating new histologic entities, extranodal dissemination, improved diagnostic methods, and advanced imaging technology.


CONCLUSIONS
This revised IPNHLSS will facilitate more precise staging for children and adolescents with NHL and facilitate comparisons of efficacy across different treatment strategies, various institutions, multicenter trials, and cooperative groups by allowing for reproducible pediatric-based staging at diagnosis and relapse.
Angelo Rosolen, University of Padova, Padova, Italy; Sherrie L. Perkins, University of Utah Health Sciences Center, Salt Lake City, UT; C. Ross Pinkerton, University of Queensland, Brisbane, Queensland, Australia; R. Paul Guillerman, Texas Children's Hospital, Houston, TX; John T. Sandlund, St Jude Children's Research Hospital, Memphis, TN; Catherine Patte, Institut Gustave Roussy, Paris, France; Alfred Reiter, Justus-Liebig University of Giessen, Giessen, Germany; and Mitchell S. Cairo, New York Medical College, Valhalla, NY.
Angelo
A
Rosolen
Angelo Rosolen, University of Padova, Padova, Italy; Sherrie L. Perkins, University of Utah Health Sciences Center, Salt Lake City, UT; C. Ross Pinkerton, University of Queensland, Brisbane, Queensland, Australia; R. Paul Guillerman, Texas Children's Hospital, Houston, TX; John T. Sandlund, St Jude Children's Research Hospital, Memphis, TN; Catherine Patte, Institut Gustave Roussy, Paris, France; Alfred Reiter, Justus-Liebig University of Giessen, Giessen, Germany; and Mitchell S. Cairo, New York Medical College, Valhalla, NY.
Sherrie L
SL
Perkins
Angelo Rosolen, University of Padova, Padova, Italy; Sherrie L. Perkins, University of Utah Health Sciences Center, Salt Lake City, UT; C. Ross Pinkerton, University of Queensland, Brisbane, Queensland, Australia; R. Paul Guillerman, Texas Children's Hospital, Houston, TX; John T. Sandlund, St Jude Children's Research Hospital, Memphis, TN; Catherine Patte, Institut Gustave Roussy, Paris, France; Alfred Reiter, Justus-Liebig University of Giessen, Giessen, Germany; and Mitchell S. Cairo, New York Medical College, Valhalla, NY.
C Ross
CR
Pinkerton
Angelo Rosolen, University of Padova, Padova, Italy; Sherrie L. Perkins, University of Utah Health Sciences Center, Salt Lake City, UT; C. Ross Pinkerton, University of Queensland, Brisbane, Queensland, Australia; R. Paul Guillerman, Texas Children's Hospital, Houston, TX; John T. Sandlund, St Jude Children's Research Hospital, Memphis, TN; Catherine Patte, Institut Gustave Roussy, Paris, France; Alfred Reiter, Justus-Liebig University of Giessen, Giessen, Germany; and Mitchell S. Cairo, New York Medical College, Valhalla, NY.
R Paul
RP
Guillerman
Angelo Rosolen, University of Padova, Padova, Italy; Sherrie L. Perkins, University of Utah Health Sciences Center, Salt Lake City, UT; C. Ross Pinkerton, University of Queensland, Brisbane, Queensland, Australia; R. Paul Guillerman, Texas Children's Hospital, Houston, TX; John T. Sandlund, St Jude Children's Research Hospital, Memphis, TN; Catherine Patte, Institut Gustave Roussy, Paris, France; Alfred Reiter, Justus-Liebig University of Giessen, Giessen, Germany; and Mitchell S. Cairo, New York Medical College, Valhalla, NY.
John T
JT
Sandlund
Angelo Rosolen, University of Padova, Padova, Italy; Sherrie L. Perkins, University of Utah Health Sciences Center, Salt Lake City, UT; C. Ross Pinkerton, University of Queensland, Brisbane, Queensland, Australia; R. Paul Guillerman, Texas Children's Hospital, Houston, TX; John T. Sandlund, St Jude Children's Research Hospital, Memphis, TN; Catherine Patte, Institut Gustave Roussy, Paris, France; Alfred Reiter, Justus-Liebig University of Giessen, Giessen, Germany; and Mitchell S. Cairo, New York Medical College, Valhalla, NY.
Catherine
C
Patte
Angelo Rosolen, University of Padova, Padova, Italy; Sherrie L. Perkins, University of Utah Health Sciences Center, Salt Lake City, UT; C. Ross Pinkerton, University of Queensland, Brisbane, Queensland, Australia; R. Paul Guillerman, Texas Children's Hospital, Houston, TX; John T. Sandlund, St Jude Children's Research Hospital, Memphis, TN; Catherine Patte, Institut Gustave Roussy, Paris, France; Alfred Reiter, Justus-Liebig University of Giessen, Giessen, Germany; and Mitchell S. Cairo, New York Medical College, Valhalla, NY.
Alfred
A
Reiter
Angelo Rosolen, University of Padova, Padova, Italy; Sherrie L. Perkins, University of Utah Health Sciences Center, Salt Lake City, UT; C. Ross Pinkerton, University of Queensland, Brisbane, Queensland, Australia; R. Paul Guillerman, Texas Children's Hospital, Houston, TX; John T. Sandlund, St Jude Children's Research Hospital, Memphis, TN; Catherine Patte, Institut Gustave Roussy, Paris, France; Alfred Reiter, Justus-Liebig University of Giessen, Giessen, Germany; and Mitchell S. Cairo, New York Medical College, Valhalla, NY. mitchell_cairo@nymc.edu.
Mitchell S
MS
Cairo
D000293:Adolescent; D001706:Biopsy; D002648:Child; D006801:Humans; D007391:International Cooperation; D008228:Lymphoma, Non-Hodgkin / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging; D008495:Medical Oncology / Q000592:standards; D064847:Multimodal Imaging; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging / Q000379:methods*; D018365:Neoplasm, Residual; D049268:Positron-Emission Tomography; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome