Prise en charge du lymphome en médecine nucléaire chez l’enfant : actualisation et particularité des lymphomes chez l’enfant

Abstract

Pediatric lymphomas account for 10–15% of childhood cancers, with treatment approaches tailored to histological subtypes such as Hodgkin lymphoma (HL), and non Hodgkin lymphomas (NHL), including Burkitt lymphoma, diffuse large B-cell lymphoma (DLBCL), and primary mediastinal B-cell lymphoma. The introduction of 18F-FDG-PET imaging has significantly transformed diagnostic and therapeutic strategies. PET enables accurate initial staging, early response assessment, and contributes to treatment de-escalation, especially in HL through Euronet protocols. In Burkitt lymphoma, PET's role is limited due to the urgency of treatment, though its high negative predictive value (93%) is notable. Pediatric DLBCL, being less aggressive, allows for PET-guided management analogous to adult practice. In primary mediastinal lymphoma, common in adolescents, interpretation challenges arise from residual low-grade metabolic uptake post-treatment, often reflecting inflammation rather than active disease. FDG-PET has become essential in personalizing pediatric lymphoma care, refining staging, and reducing overtreatment. Combined with recent advances in targeted therapies – such as anti-CD20 antibodies and CAR-T cells – this approach improves survival outcomes while minimizing long-term toxicity.