2020 CSCO Guidelines for The Diagnosis and Treatment of Lymphoma in Children and Adolescents. Lymphoma of lymphoma.

On June 21, 2020, "China Society of Clinical Oncology (CSCO) guidelines for the diagnosis and treatment of childhood and adolescent lymphoma" was successfully held online.experts and scholars in hematological oncology and pediatrics gathered online to exchange and share research results, and pay close attention to the release of the first edition of pediatric and adolescent lymphoma diagnosis guidelines.during the meeting, Professor Hao Wenpeng of Harbin Institute of Hematology and oncology gave a detailed interpretation of the guidelines for diagnosis and treatment of lymphoblastic lymphoma in children and adolescents.in children and adolescents, lymphoblastic lymphoma (LBL) accounts for about 25-35% of NHL patients, including 20-25% of B-LBL and 70-80% of t-lbl.it is highly invasive in clinic, often involving the central nervous system and bone marrow, and t-lbl is easily accompanied by mediastinal tumor and pleural effusion.1 the evaluation before treatment was only included in the level II recommendation due to the difference of PET-CT detection technology among domestic institutions.bone marrow examination should include two parts of bone marrow biopsy and bone marrow biopsy.2 pathological classification due to the poor specificity of CD99, in order to accurately diagnose t-lbl, it is recommended that CD2 / 3 / 5 / 7 be used as the detection marker, and CD4 / 8 co expression / co expression as the diagnostic basis.3 clinical staging of LBL in children and adolescents is mainly based on the revised international child NHL staging system (ipnhlss).in this staging system, it is emphasized that resection should not be considered for intraperitoneal or retroperitoneal lesions, including liver, spleen, kidney and / or ovary.bone marrow invasion is defined as a highly aggressive tumor, LBL usually invades the patient's bone marrow.the definition of bone marrow invasion in this guideline is similar to that of MICM, with emphasis on fusion morphology, immunology, cytogenetics and molecular biology test results.definition of central nervous system invasion. At present, most hospitals in China use morphological detection to judge the central nervous system invasion of patients, and some hospitals use flow cytometry for diagnosis. However, fluorescence in situ hybridization (FISH) and molecular biology technology with higher accuracy have not been popularized.if the application of fish and molecular biological detection can be expanded, the diagnosis rate of central nervous system invasion will be improved.4 the risk stratification of LBL patients in children and adolescents is mainly evaluated from the clinical stage and response state of the patients.5 the treatment of LBL is undergoing stage development.early treatment usually adopts NHL regimen, but its curative effect is not ideal. although the NHL regimen can produce certain effect in the short term, patients will soon develop bone marrow invasion and progress to leukemia. the later bfm-90 regimen recommended radiotherapy to prevent the central nervous system. However, due to its poor efficacy and serious side effects, it was subsequently changed to bfm-95 regimen and gave up radiotherapy. at present, the treatment of domestic centers and hospitals usually takes bfm-90 / 95 scheme as the basic framework, and adjusts the dosage according to different clinical manifestations of patients. different from other types of NHL, the treatment of B-LBL requires not only induction chemotherapy, but also certain consolidation and intensive treatment, as well as follow-up maintenance treatment. The total course of treatment is about 24 months. treatment of refractory and relapse: previous treatment results show that relapsed patients are often difficult to achieve complete remission (CR) through high-intensity chemotherapy. Relevant literature also shows that the recurrence rate of LBL is about 10-20%, while the survival rate of patients after re treatment is only 10-30%. therefore, the survival rate of patients with recurrent / refractory LBL is not optimistic. in the protocol, grade I recommends allogeneic hematopoietic stem cell transplantation after salvage chemotherapy. However, it is difficult for relapsed LBL patients to achieve CR here, so grade II recommends patients to participate in clinical trials of new drugs. in this meeting, Professor Hao Wenpeng focused on the updated details of the guidelines, and emphasized that patients should be recommended to participate in clinical trials of new drugs for the treatment of refractory and relapsed patients, so as to better promote the clinical application of new drugs. after the speech, Professor Duan Yanlong from Beijing Children's Hospital Affiliated to Capital Medical University, Liu Aichun from Cancer Hospital Affiliated to Harbin Medical University, and Professor He Xiangling from Hunan Provincial People's Hospital discussed the contents of the speech, and further discussed the role of stem cell transplantation in the treatment of LBL patients and the role of molecular biological detection technology in the detection and evaluation before treatment effect. please scan the QR code below: Stamp "read the original", and we will make progress together