《肿瘤瞭望》：儿童NHL和成人NHL有何不同？

Burkhardt教授：NHL可能更准确地说是一个连续的疾病，发生在儿童，然后伴随于青年和成人。根据患者的年龄疾病的亚型和生物学行为会有不同，但我不认为在儿童NHL和成人NHL中有明确的分界。不同年龄组的NHL有不同的特征。有些组织学亚型在儿童中比例更高，有些则在成人和儿童中均可出现。对于亚型我们的确需要更多的研究去鉴别其生物学行为的差别。

It is probably more of a continuous disease that occurs in children and into adolescence and then adulthood. The subtype and biology might vary according to the patient’s age， but I don’t think there is a clear border between pediatric and adult non-Hodgkin’s lymphoma. It is a continuous disease with specificities within respective age groups. There are histological subtypes that occur in children that vary from those that usually occur in adults but there are also subtypes that occur in both adults and children. For those subtypes， we really need more data to determine their biological differences.

《肿瘤瞭望》：对于复发难治的T-NHL来说，异基因造血干细胞移植的地位如何？其地位在儿童及成人中有何区别？

Burkhardt教授：儿童最常见的是T淋巴母细胞淋巴瘤和间变大细胞淋巴瘤。对于T淋巴母细胞淋巴瘤，柏林-法兰克福-蒙斯特(BFM)工作组建议采用大剂量化疗，复发时考虑自体干细胞移植。目前为止，还未确定哪些患者属于高危组，在第一次缓解后适合移植。相对而言，间变大细胞淋巴瘤已有区分低危险和高危组的分子生物标志物。低危组患者一线治疗并不是自体移植；对于高危组患者，如果化疗耐药，是否移植需要因人而异，当高危组患者疾病复发时，则需要行自体移植。总之，在儿童和成人中少见淋巴瘤亚型的T细胞淋巴瘤，仍有很多领域尚不清楚，一些高危的肝脾γδT细胞淋巴瘤患者在第一次缓解后也有移植指征，但具体病例还需具体讨论。

In children， we primarily see T-cell lymphoblastic lymphoma and anaplastic large cell lymphoma. For T-cell lymphoblastic lymphoma， the experience of the BFM group supports a clear role for high-dose chemotherapy and allotransplant at the time of relapse. We have not yet identified a highest-risk group who would be candidates for transplant at first remission， but there are molecular data supporting the idea that it will be possible to identify a very high-risk T-cell lymphoblastic lymphoma that would be an indication for allotransplant at first remission. Regarding anaplastic large cell lymphoma， there are again molecular data available that stratify patients into low- and high-risk groups. For the low-risk patients， there is no indication for allotransplant as first-line treatment. For high-risk patients， if they develop resistance to treatment， they have an indication but this is determined on an individual basis. At the time of relapse， it depends again on the risk profile. There are high-risk anaplastic large cell lymphoma patients who have an indication for allotransplant at the time of relapse. For peripheral T-cell lymphoma， which is a rare subtype of lymphoma in children and adolescents， the field is unclear. There are some high-risk hepatosplenic gamma-delta T-cell lymphomas which have an indication at first remission but this always has to be discussed with the individual case.

《肿瘤瞭望》：儿童Burkitt淋巴瘤采用目前标准的治疗策略和方案，生存率大于80%，而成人Burkitt淋巴瘤其预后却很差，您认为这其中的原因是什么？

Burkhardt教授：应用利妥昔单抗后，成人Burkitt淋巴瘤的预后明显改善。儿童Burkitt淋巴瘤采用标准治疗方案治疗的疗效优于成人，其原因可能是因为儿童可以接受更强的化疗，成人应用化疗方案时往往需要减量；此外，儿童Burkitt淋巴瘤合并症更少，可以立即治疗，而对于成人则需要考虑心脏毒性及其他等。

The prognosis for Burkitt’s lymphoma in adults has improved dramatically since the introduction of rituximab (not in the range of 80%， but close by). This was an important additional drug in the treatment of Burkitt’s lymphoma. It might be that children can accept more intense chemotherapy. The adults use the same regimen but usually at reduced intensity which may be influencing the overall outcomes. Children also have few problems with comorbidities. If you have a child with Burkitt’s lymphoma， you can start treatment immediately whereas in an adult patient， you have to consider cardiac toxicity and so on.