Optimizing Outcomes in Childhood Mature B-cell Non-Hodgkin Lymphoma: Insights Into Staging, Risk Stratification, and Response Evaluation.

Abstract

Staging and risk stratification are critical components in optimizing treatment for pediatric mature B-cell non-Hodgkin lymphoma (B-NHL), an aggressive malignancy with high cure rates when appropriately managed. This review examines contemporary approaches to staging and risk classification through case-based scenarios, emphasizing the practical and patient-centered applications of recent advancements in diagnostic imaging, risk assessment, and biochemical profiling. Through detailed clinical cases, we examine the role of PET-CT and other imaging modalities in accurate staging, outline key criteria for risk categorization, and highlight factors such as tumor burden, central nervous system (CNS) involvement, and early treatment response that influence therapeutic intensity. We also discuss the integration of early response assessments, including PET scans, within current response-adapted treatment frameworks. By illustrating the nuances of individualized staging and risk stratification across diverse patient presentations, this review offers clinicians practical, evidence-based guidance to enhance treatment efficacy while minimizing long-term toxicity in pediatric B-NHL.