Understanding AYA Lymphoma Care and Why Treatment May Differ by Age

Being an adolescent or young adult patient with lymphoma often requires different, more specialized care than pediatric and adult patients, according to Dr. Andrew M. Evens.

In order to further delve into this topic, Evens sat down for an interview with CURE. He shared his insights on what makes lymphoma in this patient population so different from the cases that are diagnosed in children or older adults, as well as how how this impacts treatment planning.

Evens holds multiple positions, including deputy director for clinical services at Rutgers Cancer Institute of New Jersey; associate vice chancellor of Clinical Innovation & Data Analytics at Rutgers Health; system director of medical oncology, and oncology lead for RWJBarnabas-Rutgers Medical Group, RWJBarnabas Health; and professor of medicine at Rutgers Robert Wood Johnson Medical School, all located in New Brunswick, New Jersey.

Transcript:

When we say adolescent and young adults, or AYAs… at least through the lens of the National Institutes of Health, it [includes] patient’s aged 15 to 39 [years]. The reason that age range is so important is it tends to be an overlap between our pediatric oncologists, who obviously will treat children well below age 10 and even into their 20s and sometimes into their 30s, even though that official definition goes up to 39 — usually it won't be often above 30, but certainly into the 20s.

On the other hand, an adult oncologist like myself, with different training (you go to a pediatric program for pediatric oncology or internal medicine and hematology-oncology or radiation oncology), we will usually treat our youngest patients starting at age 18 years and above, with no upper age limit. That age range from 18 to the low 30s has an overlap, and that's important because it can sometimes lead to a disparity of viewpoints and recommendations, at least historically.

When it comes to treatment planning, that's always going to be a factor: is the AYA patient, whether with Hodgkin lymphoma or non-Hodgkin lymphoma (let's say a 25-year-old), seeing a pediatric oncologist or an adult oncologist? You would think it would be identical, but it often is not. Historically, we have treated patients not radically differently, but slightly differently, and slight differences can sometimes be really important.

It always [comes down to]: what is the diagnosis? What's the exact subtype of lymphoma? That's regardless of pediatric or adult. What's the stage, meaning, where is it in the body? That's similar, if not close to identical, between us, assessed with blood tests and a PET scan, a whole-body scan that we'll do. Then, it's about coming up with the best treatment based on that subtype of lymphoma and stage. Of course, we're always looking for a clinical trial.

When we say clinical trial, we don't mean experimental. We mean we're always trying to do better than the standard of care. If there's a certain standard of care, that's great. How can we do even better and/or with less side effects? So, just in terms of big-picture treatment planning, those are some of the really important components.

Transcript has been edited for clarity and conciseness.

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