Staging Of Lymphoma Research Articles

История вопроса о роли биопсии костного мозга в системе стадирования классической лимфомы Ходжкина и современный взгляд в эру ПЭТ-КТ (обзор литературы)

The staging of Hodgkin lymphoma lays the groundwork for optimal treatment decision making. For a long time, bone marrow assessment has been an integral part of staging. The study of bone marrow involvement in tumor progression includes radiological method and morphological analysis of its core biopsy samples. During the last five decades of using bone marrow core biopsy, the attitude of oncologists and hematologists to this invasive and painful procedure remained ambivalent between denying and affirming the need to carry it out in all or most Hodgkin lymphoma cases. The present review provides the historical background of bone marrow core biopsy and considers its appropriateness for patients with classical Hodgkin lymphoma.

Extracorporeal membrane oxygenation in long-term COVID-19 with severe neutropenia and thrombocytopenia after allogeneic hematopoietic stem cell transplantation: a case report

BackgroundHematopoietic stem cell transplantation (HSCT) was associated with potentially life-threatening complications. Among patients supported by extracorporeal membrane oxygenation (ECMO), those who underwent HSCT had a worse prognosis than those who did not. Advances in HSCT and critical care management have improved the prognosis of ECMO-supported HSCT patients.CaseThe patient in the remission stage of lymphoma after 22 months of allogeneic hematopoietic stem cell transplantation, suffered from ARDS, severe neutropenia, thrombocytopenia, and long-term COVID-19. We evaluated the benefits and risks of ECMO for the patient, including the possibility of being free from ECMO, the status of malignancy, the interval from HSCT to ARDS, the function of the graft, the amount of organ failure, and the comorbidities. ECMO was ultimately used to save his life.ConclusionsWe did not advocate for the general use of ECMO in HSCT patients and we believed that highly selected patients, with well-controlled tumors, few comorbidities, and fewer risk factors for death, tended to benefit from ECMO with well ICU management.

Bone marrow biopsy in geriatric patients above the age of 85 years: invaluable or unnecessary? A retrospective analysis

Bone marrow biopsy (BMB) is a well-established diagnostic tool for various hematological, oncological, and other medical conditions. However, treatment options for geriatric patients (pts) facing these diseases are often constrained. In this single-center, retrospective analysis we assessed the diagnostic value of BMB in geriatric pts aged ≥ 85 years and examined its impact on therapeutic decisions. We examined 156 BMB procedures in 129 pts, extracting data from the electronic patient records and applying descriptive statistical methods. Nearly half of the primary diagnostic procedures (26; 44.1%) resulted in a modification of the initially suspected diagnosis. Notably, 15 (25.4%) of these procedures, led to changes in both the diagnosis and planned interventional treatment. Among the 15 follow-up procedures (36.6%), disease progression was initially suspected based on symptoms, but BMB results excluded such progression. In lymphoma staging biopsies, only 2 (3.6%) prompted a change in therapeutic intervention. Importantly, no BMB-related complications, such as bleeding, infection or nerve damage, were reported. Median survival after BMB was 16.1 months across all pts, yet it varied based on the diagnosis and comorbidity score. The survival of pts with a change in therapy based on BMB results did not significantly differ from those who did not undergo a therapy change. In conclusion, BMB proved to be generally safe and beneficial in this geriatric cancer patient cohort beyond the age of 85 years. However, the advantages of lymphoma staging in this patient population warrant further consideration.

An Evaluation of Hemostatic Dysregulation in Canine Multicentric Lymphoma

Multiple hemostatic abnormalities are associated with paraneoplastic syndrome and some malignant tumors. Lymphoma is the most common hematopoietic neoplasm in dogs, sometimes associated with hemostatic changes. The objectives of this study were to evaluate the behavior of coagulation parameters in dogs with multicentric lymphoma compared with diseased dogs without lymphoma, to separately evaluate the effect of immunophenotype (B lymphoma versus T lymphoma) on the variables of interest as well as the effect of disease stage (stage II to IV versus stage V). Specifically, a cross-sectional study was performed with a matched comparison group considering 170 dogs with B or T lymphoma (group 1) and 170 dogs with no lymphoma or other neoplastic processes but other diseases (group 0). Eight coagulation parameters were evaluated: platelet count (Plt), activated partial thromboplastin time (aPTT), prothrombin time (PT), thrombin time (TT), fibrinogen, fibrin/products of fibrinogen degradation (FDPs), fibrin D-dimers, and antithrombin (AT). Dogs with lymphoma showed prolonged PT and TT, decreased fibrinogen, increased FDP, and decreased Plt compared with group 0. The effect of disease stage was evaluated separately for dogs with stage II to IV lymphoma and dogs with stage V lymphoma; patients with stage II–IV lymphoma showed no significant differences, while in dogs with stage V lymphoma, a prolongation of PT and TT, a decrease in fibrinogen, an increase in FDPs and a decrease in Plt were found compared with the group 0. Finally, the comparison between B lymphoma and T lymphoma showed no significant differences in coagulation parameters between the two groups. Logistic regression analysis demonstrated that low fibrinogen and platelet levels were the most significant predictors of lymphoma in a cohort of canine patients. These hemostatic abnormalities in lymphoma appeared to be associated with the stage of the disease rather than the lymphoma immunophenotype. These findings pave the way for the possible scenario of lymphoma-associated fibrinolysis and the so far undescribed pattern of hyperfibrinolysis associated with the most severe stage of lymphoma.

Comparative effectiveness of standard vs. AI-assisted PET/CT reading workflow for pre-treatment lymphoma staging: a multi-institutional reader study evaluation.

Fluorine-18 fluorodeoxyglucose (FDG)-positron emission tomography/computed tomography (PET/CT) is widely used for staging high-grade lymphoma, with the time to evaluate such studies varying depending on the complexity of the case. Integrating artificial intelligence (AI) within the reporting workflow has the potential to improve quality and efficiency. The aims of the present study were to evaluate the influence of an integrated research prototype segmentation tool implemented within diagnostic PET/CT reading software on the speed and quality of reporting with variable levels of experience, and to assess the effect of the AI-assisted workflow on reader confidence and whether this tool influenced reporting behaviour. Nine blinded reporters (three trainees, three junior consultants and three senior consultants) from three UK centres participated in a two-part reader study. A total of 15 lymphoma staging PET/CT scans were evaluated twice: first, using a standard PET/CT reporting workflow; then, after a 6-week gap, with AI assistance incorporating pre-segmentation of disease sites within the reading software. An even split of PET/CT segmentations with gold standard (GS), false-positive (FP) over-contour or false-negative (FN) under-contour were provided. The read duration was calculated using file logs, while the report quality was independently assessed by two radiologists with >15 years of experience. Confidence in AI assistance and identification of disease was assessed via online questionnaires for each case. There was a significant decrease in time between non-AI and AI-assisted reads (median 15.0 vs. 13.3 min, p < 0.001). Sub-analysis confirmed this was true for both junior (14.5 vs. 12.7 min, p = 0.03) and senior consultants (15.1 vs. 12.2 min, p = 0.03) but not for trainees (18.1 vs. 18.0 min, p = 0.2). There was no significant difference between report quality between reads. AI assistance provided a significant increase in confidence of disease identification (p < 0.001). This held true when splitting the data into FN, GS and FP. In 19/88 cases, participants did not identify either FP (31.8%) or FN (11.4%) segmentations. This was significantly greater for trainees (13/30, 43.3%) than for junior (3/28, 10.7%, p = 0.05) and senior consultants (3/30, 10.0%, p = 0.05). The study findings indicate that an AI-assisted workflow achieves comparable performance to humans, demonstrating a marginal enhancement in reporting speed. Less experienced readers were more influenced by segmentation errors. An AI-assisted PET/CT reading workflow has the potential to increase reporting efficiency without adversely affecting quality, which could reduce costs and report turnaround times. These preliminary findings need to be confirmed in larger studies.

Chest Computed Tomography for Lymphoma Staging: A Wasted Opportunity for Cardiovascular Risk Stratification?

Patients with a lymphoma diagnosis undergo non-gated chest computed tomography (CT) scans as part of cancer diagnosis or staging. Although coronary artery calcification (CAC) is traditionally evaluated on dedicated cardiac CT, CAC can also be detected on standard chest CT. This exploratory study aimed to determine the prognostic value of CAC detected on non-gated chest CT and to report its use on clinical practice. Consecutive patients with a lymphoma diagnosis who performed non-contrasted non-gated chest CT for cancer diagnosis or staging were included and retrospectively evaluated. Coronary artery calcification was evaluated by quantitative (Agatston score) and qualitative (visual) assessment. Fifty-seven patients were included in this study (mean age 61±15 years; 58% male). Coronary artery calcification was identified in 22 patients (39%), most of them with multi-vessel involvement. Coronary artery calcification was qualitatively classified as mild, moderate and severe in 11%, 19% and 9% patients, respectively. This study suggested that moderate or severe CAC was an independent predictor of all-cause mortality (odds ratio 3, 95% confidence interval 2-11; p=0.04) after adjusting for cardiovascular risk factors and lymphoma staging. Regarding quantitative evaluation, a higher CAC score was also associated with higher mortality. While significant CAC was identified in 22 patients, it was only reported in four patients. The preliminary findings of this hypothesis-generating study support the investigation of CAC identified by chest CT for diagnosis/staging of cancer as a risk modifier in the global risk assessment of patients with lymphoma. The unrecognition and underreporting of this finding may represent a wasted opportunity to detect subclinical coronary atherosclerosis in these patients and may help in guiding preventive cardiology care.

Role of 2-(fluorine-18) Fluoro-2-deoxy-D-glucose Positron Emission Tomography/Computed Tomography in Initial Staging and Bone Marrow Involvement Prediction in Patients with Newly Diagnosed Lymphoma in Correlation with Bone Marrow Study.

Lymphoma is a common malignant proliferative disease in which bone marrow infiltration will upstage the disease and thus affect prognosis of the disease. As of now bone marrow biopsy is considered as a reference standard to find out bone marrow involvement in lymphoma. Performing an invasive and painful intervention in all newly diagnosed lymphoma patients is controversial. PET-CT is a non-invasive technique that gives functional information about the cells using the glucose metabolism. It can detect early bone marrow and extra medullary organ involvement which can lead to restaging of the disease. These advantages make PET-CT a valuable adjunct in diagnosis of lymphoma. Our study aims to evaluate the usefulness of 18 F-FDG PET-CT, a non-invasive, semi quantitative whole body imaging technique for detection of early bone marrow and extra medullary organ involvement in lymphoma patients which in turn can obviate the need for bone marrow study (BMS). The primary objective of study is to categorise FDG uptake in bone marrow as diffuse /unifocal /multifocal / no uptake and to correlate pattern of FDG uptake to bone marrow study. Our study also assesses the role of FDG PET/CT in staging of lymphoma. Thirty patients with newly diagnosed lymphoma in the age group 18 to 75 years of both sexes within 3 months of diagnosis and who have not been started on any treatment was included in the study. Marrow uptake on FDG PET/CT has been categorized as diffuse, unifocal, multifocal and no uptake. Agreement between bone marrow study and FDG PET/CT has been assessed by reliability analysis using Cohen's kappa. Sensitivity, specificity, PPV, NPV of PET/CT in detecting marrow involvement have been calculated. The sensitivity, specificity, PPV, NPV and accuracy of 18 F-FDG PET-CT in detecting marrow involvement of lymphoma cases are 86.6%, 77.7%, 68.4%, 91.3% and 80.9% respectively. 18 F-FDG PET-CT detected bone marrow involvement in 86.6% (13 out of 15 total positive cases) cases of lymphoma which included both HL and NHL. Reliability analysis using Cohen's kappa is used to test the agreement between bone marrow study and 18F-FDG PET/CT. k value of 0.6 was obtained which showed a moderate agreement between bone marrow study and 18F-FDG PET/CT in marrow assessment. 18F-FDG PET/CT is a highly sensitive imaging modality which can pick up extra-nodal organ and BMI in patients with lymphoma and can upstage the disease and alter treatment strategies. PET-CT cannot completely replace the bone marrow study. However, being an invasive painful procedure, BMB can be avoided in cases with unifocal or multifocal marrow involvement on PET-CT.

Recent advancements in 18F-FDG PET/CT for the diagnosis, staging, and treatment management of HIV-related lymphoma.

Infection with the Human Immunodeficiency Virus (HIV) is one of the most pressing issues facing public health on a worldwide scale. Currently, HIV-related lymphoma is the most common cause of death among people living with HIV, and warrants more attention. The unique challenges associated with HIV-related lymphoma management derive from the underlying HIV infection and its immunosuppressive effects. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) has gained significant prominence in the past few years as a valuable diagnostic and therapeutic instrument for the treatment of HIV-related lymphoma. This review will start with an overview of the subtypes, risk factors, and therapeutic choices for individuals with HIV-related lymphoma. We will then briefly discuss the current application of 18F-FDG PET/CT in the medical management of HIV-related lymphoma patients, followed by the initial staging of the disease, the evaluation of therapeutic response, the prediction of prognostic outcomes, the decision-making process for radiotherapy guided by PET findings, and the distinguishing of various diagnoses.

10020-ML-1 SENTINEL LESION PRECEDING PRIMARY CENTRAL NERVOUS SYSTEM LYMPHOMA

Abstract It has been reported that there are rare cases of spontaneous resolution, which are referred to as sentinel lesions in the early stages of primary malignant lymphoma of the central nervous system (PCNSL). In this study, we examined cases of PCNSL that presented with a sentinel lesion. Of the 43 PCNSL cases biopsied at our institution between 2011 and 2022, three cases were difficult to diagnose on initial biopsy. No preoperative steroids were used in all patients, and postoperative CT or MRI confirmed that the lesions were appropriately sampled from the targeted lesions. Since the diagnosis was not confirmed by the initial biopsy and symptoms were stable, the patients were followed up without chemotherapy, but symptoms worsened around 6 months later, and MRI showed recurrent large lesions. Another biopsy was performed in all patients, and a definitive diagnosis of diffuse large B-cell lymphoma (DLBCL) was finally obtained. It has been reported that sentinel lesions in PCNSL are characterized by demyelination or nonspecific inflammation on initial pathology and spontaneous resolution of lesions, which are estimated to be changes mediated by immunological mechanisms. In the present study, the course of symptoms was characterized by a relatively slow progression, and diffusion-weighted images at the initial onset did not show as high a signal as in usual PCNSL. Multiple biopsies are required to make a definitive diagnosis, and careful follow-up of symptoms and images and determination of the appropriate timing of biopsy are important.

Radiotherapy of Orbital and Ocular Adnexa Lymphoma: Literature Review and University of Catania Experience.

Orbital and ocular adnexa lymphomas are rare neoplasms confined to the orbital region. The prognosis is generally favorable, with a high proportion of localized disease, indolent clinical course, prolonged disease-free intervals, and low lymphoma-related mortality rate. We report our experience on eleven patients with confirmed histological diagnosis of lymphoma stage IE-IIE, treated between 2010 and 2021 with radiotherapy alone or in association with chemotherapy or immunotherapy. Eight patients were treated with primary radiotherapy only, while three received previous systemic treatments. Six patients were treated with Proton beam therapy (PBT), and five with external beam radiotherapy (EBRT). The five-year local control rate was 98%; only one patient developed an out-of-field recurrence. We also conducted a comprehensive literature review using electronic databases (PubMed, EMBASE, and Cochrane Library). Articles were selected based on their pertinence to treatment of the ocular and adnexal lymphoma focusing on radiotherapy techniques (electron beam radiotherapy, photon beam radiotherapy, or proton beam radiotherapy), treatment total dose, fractionation schedule, early and late radio-induced toxicities, and patient's clinical outcome. Radiotherapy is an effective treatment option for orbital lymphoma, especially as standard treatment in the early stage of orbital lymphoma, with excellent local control rate and low rates of toxicity.

A Rare Case of Incidental Primary Follicular Lymphoma Co-Existing With Grade Group 5 Prostatic Adenocarcinoma

Abstract Introduction/Objective Primary lymphoma of the prostate is an exceedingly rare entity comprising less than 0.1% of all prostatic cancers with follicular lymphoma making up only 12% of primary prostatic lymphomas. There is very limited literature owing to their rarity and underdiagnosis. To the best of our knowledge, prostatic adenocarcinoma with an incidental follicular lymphoma presenting as a prostate imaging reporting and data system 4 (PI-RADS 4) lesion on multiparametric magnetic resonance imaging (mpMRI) with mildly elevated serum prostate specific antigen (PSA) has not been previously described. Methods/Case Report A 73 year old male presented to Danbury Hospital for follow up on benign prostatic hyperplasia (BPH) diagnosed in 2020. The patient was experiencing nocturia and had a serum PSA of 4.8. Multiparametric MRI revealed an enlarged, 5.5 x 4.1 x 3.3 cm, prostate gland (estimate weight of 45.5 grams) with a 1.2 cm PI-RADS 4 lesion in the right anterior mid gland. There was no evidence of metastatic disease on his most recent body imaging. He was subsequently scheduled for prostate needle biopsy. Histopathology showed a high grade prostatic adenocarcinoma, with a Gleason score 4 + 5=9, along with a focally prominent dense lymphoid infiltrate in four of four cores from the same area of abnormality that was detected on mpMRI. The latter comprised of ill defined follicles and sheets of small cleaved atypical lymphoid cells consistent with centrocytes and very few centroblasts. By immunohistochemical staining, the atypical cells in lymphoid follicles and interfollicular areas were positive for CD20, CD10 and BCL2 and negative for cyclin D1. CD21 stain highlighted the follicular dendritic cell meshwork in the germinal centers with a low Ki67 proliferation index. A final diagnosis of low grade follicular lymphoma (grade1-2) coexisting with the prostatic adenocarcinoma was rendered. The patient is currently undergoing lymphoma staging as the treatment for adenocarcinoma is planned. Results (if a Case Study enter NA) NA Conclusion Primary lymphoma of the prostate usually presents with non specific obstructive voiding symptoms and normal or near normal PSA levels which makes it challenging for physicians to suspect lymphomas. The lymphocytic infiltrate, originally thought to be prostatitis, underwent further evaluation with immunohistochemistry due to its monotonous appearance, which clinched the final diagnosis. Careful evaluation of prostate core needle biopsies is necessary even after spotting carcinoma in order to rule out low grade lymphomas.

PET/CT Enables Appropriate Staging in Extranodal Marginal Zone Lymphoma

Introduction: PET/CT is the standard-of-care for staging and therapy response assessment in lymphoma. Fluorodeoxyglucose (FDG)-avidity in extranodal marginal zone lymphoma (EMZL) remains controversial with some variability by extranodal location. The current Lugano classification recommends the use of CT scans only in staging and follow-up for EMZL. However, emerging data from small studies have challenged this suggestion. In this study we aimed to determine the ability of PET/CT to detect FDG-avid EMZL during staging work-up. Methods: First, we retrospectively analyzed the University of Miami (UM) MZL database (period 2/2016-1/2023) searching for patients who underwent staging PET/CT. Images were reviewed by expert radiologists to ascertain avidity of tumor and not surrounding tissue, with specific attention to ocular and GI locations; if scans were not available (n=15), we retrieved data from reports (results presented in part at ICML2023). Next, we aimed to validate the initial UM results additionally analyzing data from imaging reports for patients prospectively enrolled in the Lymphoma Epidemiology of Outcomes (LEO) MZL cohort (period 7/2015-5/2020), excluding LEO patients from Miami to avoid overlap. Patients with high-grade transformation at diagnosis were excluded. For patients with &amp;gt;1 extranodal site, each location was counted independently. We considered FDG-avid disease if SUVmax was ≥2 as this value is commonly observed between mediastinal blood pool (BP) and liver background. To normalize data, we calculated ratios of lymphoma SUVmax versus both BP and liver background, as available. Patients without measurable disease were excluded from analysis. Results: Among 210 patients with EMZL in the UM cohort, 152 had staging PET/CT and were analyzed. Twenty-two patients demonstrated &amp;gt;1 extranodal site providing a total of 187 locations. The LEO cohort included 411 patients from 7 centers, with 235 having available imaging reports. Fifty-two patients in this cohort demonstrated &amp;gt;1 extranodal site providing a total of 306 locations. Disease distribution is depicted in Table 1. Among 187 EMZL locations in the UM cohort, the most common were gastric (n=33, 17.6%), ocular (n=31, 16.6%), lung (n=30, 16%), skin and soft tissue (n=16, 8.6%, each). Similarly, lung (n=63; 20.6%), soft tissue (n=46; 15%), gastric and ocular (n=34 each; 11%) were common locations in the LEO cohort. EMZL demonstrated FDG-avidity (SUVmax ≥2) across all locations with identical values in both cohorts (UM= 78.1% &amp; LEO= 76.5%). FDG-avidity by location is shown in Table 1A &amp; B with salivary gland (100% &amp; 100%), lung (93.3% &amp; 95.2%), soft tissue (93.8% &amp; 100%), and airways (90.9% &amp; 100%) demonstrating high avidity in both cohorts. Contrarily, skin was commonly non-FDG avid (93.8% &amp; 81%). The median size of FDG-avid lesions was 2.4cm (range, 0.7-17.4) in UM and 2.9cm (range, 0.1-12) in LEO cohorts. In patients with &amp;gt;1 extranodal site FDG-avidity was nearly universal across sites (UM=93% &amp; LEO=100%). We observed a significant correlation between lymphoma size and FDG-avidity for UM (r=0.33; P=0.001), and for LEO (r=0.55; P&amp;lt;0.0001). In patients with background FDG-avidity data in the UM cohort (n=150), a BP index and liver index ≥1 detected lymphoma in 79.3% &amp; 71.5% cases, respectively. We were unable to calculate indexes in LEO cohort since only limited data on BP (n=26) and liver (n=19) background was available in imaging reports. Conclusions: This study represents the largest analysis evaluating accuracy of PET/CT to determine initial tumor burden in 387 patients with EMZL. We demonstrate that EMZL is largely an FDG-avid disease across two cohorts, and PET/CT should be included in the staging of these patients while acknowledging possible limited sensitivity in GI locations due to physiologic uptake. Furthermore, we observed that patients with multiple extranodal locations demonstrate uniform FDG-avidity across all sites except for skin involvement. Based on our results we recommend the incorporation of PET/CT into standard staging of EMZL in planned revised Lugano classification guidelines. In those demonstrating initial FDG-avidity, a lower SUVmax threshold of SUVmax ≥2, comparison to mediastinal BP rather than to liver background activity and evaluating for resolution of focal FDG-avidity should be considered to assess treatment response in routine care and clinical trials.

CNS Involvement in Pediatric Hodgkin Lymphoma: A Comprehensive Retrospective Analysis from the Staging, Evaluation and Response Criteria Harmonization (SEARCH) for Childhood, Adolescent and Young Adult Hodgkin Lymphoma (CAYAHL) Group

Introduction Hodgkin lymphoma (HL) accounts for approximately 7% of childhood cancer, most frequent in adolescents and young adults. In contrast to non-Hodgkin lymphoma (NHL), central nervous system (CNS) involvement at the time of diagnosis with HL is rare and poorly understood. Information regarding the clinical presentation, management, response to treatment and outcome of patients who exhibit this finding is limited to case reports or small series. We sought to describe CNS involvement at the time of diagnosis with pediatric HL by performing a retrospective analysis of 3 large international clinical trials. Methods Patients with CNS involvement were identified from the imaging databases of the COG trial AHOD1331 (NCT02166463) and EuroNet trials PHL-C1 (NCT00433459, EudraCT 2006-000995-33) and PHL-C2 (NCT02684708, EudraCT 2012-004053-88). Imaging was reviewed collaboratively by COG and Euronet radiologists and nuclear medicine physicians with expertise in HL, with input from radiation oncologists and pediatric oncologists. All identified cases of CNS involvement had morphologic (CT) and metabolic (FDG-PET) imaging prior to initiation of therapy, as well as disease response assessment after 2 cycles of therapy. Variables evaluated included: age, sex, Ann Arbor stage, histology, symptoms at the time of presentation (pain, neurologic symptoms), corticosteroid administration prior to FDG-PET scan, number and location of CNS lesions, tissue of origin of the CNS lesion, anatomic description of the involvement of the CNS lesion, number and location of E-lesions, whether emergency irradiation or an operative procedure were performed at diagnosis, FDG tracer uptake at the time of initial staging, response of the CNS lesions after 2 cycles of chemotherapy, whether relapse occurred and in which location. CNS involvement was defined in 2 ways: (1) lesions originating within the CNS parenchyma and (2) lesions extending into the CNS. Results 45 patients with 55 CNS lesions were identified from a combined cohort of 5569 patients with a new diagnosis of HL. 9 patients presented with pain and 4 with neurologic symptoms, however information regarding clinical symptoms was not available for 34/45 patients. Symptoms corresponded to the location of the CNS lesion. All identified lesions extended into the CNS from surrounding tissue, none originated within the CNS parenchyma. 82.2% of patients had a single lesion extending into the CNS, most commonly through the neural foramina into the thoracic spine (45.5%), sacrum (23.6%) or lumbar spine (21.8%). Lesions originated from adjacent bone (45%) or soft tissue (40%). 89% of patients with CNS lesions had stage IV HL, and 68.8% had extranodal (non-CNS) disease. 54.8% of lesions displaced the spinal cord, but none infiltrated the spinal cord itself. After 2 cycles of chemotherapy, 67.3% of CNS lesions had a &amp;gt;75% reduction in size or complete resolution, and 32.7% of CNS lesions decreased in volume by 50-75%. A residual mass was present for 74% of lesions involving the neural foramina after 2 cycles of chemotherapy. 89.1% of lesions were PET negative at interim response assessment (IRA). 2 CNS lesions were associated with relapse at the CNS site, these were PET negative at IRA. 13 lesions received irradiation, none of these were sites of subsequent relapse. Conclusions This large, combined cohort of intermediate- and high-risk pediatric patients enrolled on clinical trials from 2007 to 2021 confirms the rarity of CNS involvement at the time of diagnosis with HL, with an overall incidence of 0.8%. Importantly, CNS lesions extended from adjacent tissue and did not originate within the CNS itself. These lesions never directly infiltrated the brain parenchyma or spinal cord. They were highly metabolically active at diagnosis, and demonstrated an excellent metabolic and morphologic response to the first 2 cycles of chemotherapy. Patients with CNS involvement had a 2-fold greater incidence of extranodal disease than previously reported cohorts. In summary, this retrospective study provides key information about CNS involvement in pediatric HL at the time of diagnosis, contributing to our understanding of this rare, yet important, clinical presentation.

Impact of Front-Line Treatment Interim PET/CT in Peripheral T-Cell Lymphoma Patients' Survival: Experience of a Single Center

Introduction: The introduction of PET/CT in the staging and response assessment to therapy has changed the clinical evaluation of most lymphomas, especially Hodgkin lymphoma and aggressive B-cell lymphomas. The use of PET/CT in the staging of peripheral T-cell lymphomas (PTCL) is already a standard of care in many centers, although its decisional role in course of chemotherapy or at the end of treatment remains unclear. Objective: The aim of this study is to evaluate the predictive role of interim PET/CT in newly diagnosed PTCL patients. Methods: We retrospectively analyzed the clinical data of adult patients diagnosed with PTCL and actively treated between 2014 and 2023 at our center. All patients were evaluated with PET/CT at different timepoints (baseline, interim and end of treatment). Results: We evaluated 49 patients, with a median age at diagnosis of 59 years (range: 18-83), and a slight predominance of females (54%) (table 1). Almost half of the patients were diagnosed of angioimmunoblastic/T-follicular helper lymphoma (AITL/TFHL) 23(47%), followed by anaplastic large cell lymphoma (ALCL) in 17 cases [9 ALK+ (18%) and 8 ALK- (17%))] and peripheral T-cell lymphoma NOS (PTCL-NOS) in 9 (18%). Seven (14%) patients had ECOG ≥ 2, 47 (90%) had stage III-IV disease, among them, 42 (84%) with extranodal involvement. Bone marrow was involved in 14 out of 36 (39%) evaluated patients. Twenty-seven (54%) patients had IPI score 3-5. Front-line treatment consisted in CHOP in 32 (65%) patients and brentuximab vedotin+CHP in 17 (35%). Interim evaluation was performed after 3 cycles in 32 (65%) and after 4 cycles in 16 (33%) patients. Only one patient was evaluated after 2 cycles due to suspected disease progression. At this time point, 31 (63%) patients were considered in complete metabolic response (CMR) with a Deauville Score (DS) 1-3, 12 (25%) in partial metabolic response (PMR) with a DS 4 and 6 (12%) patients with progressive disease (PD) with DS5. Among the latter's, 4 patients were treated with 2 nd line treatment, while 2 completed the planed 6 cycles due to significant tumor burden . Among 48 patients evaluated after 3 and 4 cycles of therapy, CMR was achieved in 18 (56%) and 13 (81%), respectively (p=0,088). Eleven (34%) and one (6%) pts were in PMR at iPET after 3 and 4 cycles, respectively. Forty-five (92%) patients completed front-line therapy and were evaluated with EOT PET/. CMR (DS1-3) was reported in 32 (71%) patients, PMR in 8 (18%) and PD in 5 (%). Among patients with CMR at iPET, 25 (81%) maintained CMR, 5 (16%) converted to PMR and only 1 (3%) progressed. Among patients with PMR at iPET, 5 (42%) converted to CMR, 4 (33%) maintained PMR and 3 (25%) progressed. Eighteen (37%) patients were consolidated with autologous stem cell transplantation, all in CMR at EOT, except for 1 patient with PMR DS4. With a median follow-up of 28 months (range: 2-107 months), 25 (51%) patients relapsed or progressed. Median progression-free survival (PFS) of the entire population was 24 months. According to interim response, median PFS of DS1-3, DS4 and DS5 were 28, 10 and 2 months, respectively (Figure 1). In univariate analysis, along traditional prognostic factors as advance stage (p=0.0324), increased LDH (0.0211), IPI ≥ 3 (0.0198) and bone marrow infiltration (0.0475), interim PET/CT (iPET) impacted on PFS (DS1-3 vs DS4 vs DS5, p=0.004; DS1-3 vs DS4-5, p=0.0233). When considering the exact timing, iPET after 4 cycles seemed to relate better with PFS (DS1-3 vs DS4 vs DS5, p=0.0009) than after 3 cycles (DS1-3 vs DS4 vs DS5, p=0.32). In the multivariate analysis, iPET/CT response maintained its prognostic significance (for DS1-3 vs DS4 vs DS5: HR 2.37, 95% CI 1,44-3,89, p=0,). Median OS was not reached. The estimated 2-year OS for the entire population was 75% (95% CI, 58-86). According to iPET, the estimated 2-year OS for DS1-3, DS4 and DS5 were 85% (60-95), 64% (30-85) and 63% (14-90), respectively. No impact of iPET was documented on . Conclusion: Our study highlights the potential role of interim PET/CT in the management of PTCL. Reaching an early metabolic complete remission seems to be associated with longer PFS. Patients with a DS4 at interim evaluation remain challenging for clinicians, since also in our study half of them converted to CMR at the end of . Further radiomics analysis may help to better identify patients at higher risk of progression and offer a more tailored treatment.

The Outcome of Diffuse Large B-Cell Lymphoma Patients with Testicular Involvement - Real World Data

Introduction: Patients (pts) with testicular lymphoma (TL) have an increased risk of central nervous system (CNS) relapse. In rituximab era, the reported incidence vary from 10% (in limited disease) to 25% (advanced disease). More data is needed to guide the managment of TL pts in current era. Optimal strategy for CNS relapse prevention is uncertain. Methods: We studied consecutive pts diagnosed between 2000 and 2022 with testicular diffuse large B-cell lymphoma (DLBCL) prospectively observed in the Czech Lymphoma Study Group Project NiHiL (Clinical Trial gov. NCT03199066). Objectives were to analyze the cumulative incidence of CNS relapse, time to CNS relapse, PFS and OS. The impact of various treatment strategies on CNS relapse was analyzed. Results: We identified 229 pts with testicular involvement: 157 pts with primary testicular lymphoma (PTL) in clinical stage I or II and 72 pts in advanced stage (AD) III or IV. Median age was 70 years (range 33 - 87). Rituximab-based chemotherapy received 192 (83.8%) pts including 127 (81%) cases with PTL. Following localized treatments were used more often in PTL compared to AD: unilateral orchiectomy [148 (94.3%) vs. 47 (65.3%); p &amp;lt; 0.0001], testicular irradiation (RT) [116 (61.7%) vs. 40 (38.7%); p = 0.005]. Most patients (85%) received some form of CNS prophylaxis. There were similar rates in use of prophylactic methotrexate (MTX) between PTL and AD (p = 0.88): intrathecal (i.t.) MTX 64 (40.8%) vs. 29 (40.3%), intravenous (i.v.) MTX with or without cytarabine 20 (12.8%) vs. 7 (9.7%); combined i.t. and i.v. MTX 38 (24.2%) vs. 20 (27.8%). Out of 229 cases 25 (15.9%) PTL and 11 (15.3%) AD pts did not receive any CNS prophylaxis. Median follow-up was 51.8 months.Overall 63 (27.5%) pts relapsed including 14 (6.1%) relapses in CNS. Median time to CNS relapse was 21.9 months and to other systemic relapse was 14.7 months (p = 0.63). The 5-year cumulative incidence of CNS relapse in PTL was 4.55% (95% confidence interval [CI], 0.1 - 28.6) and in AD 12.07% (95% CI 0.8 - 39.6), respectively. In univariate analyses, MTX prophylaxis (i.v. and/or i.t.) and testicular RT had no impact on CNS relapse (p = 0.49 and p = 0.60, respectively). Orchiectomy was the single significant factor associated with lower risk of CNS relapse in PTL (hazard ratio [HR] = 0.11[95% CI 0 - 0.124]; p = 0.001). Rituximab significantly reduced CNS relapse in AD with testicular involvement (HR = 0.1002 [95% CI 0.0 - 0.45]; p = 0.0005). Out of 14 pts with CNS relapse 8 died due to lymphoma progression. Median progression-free survival (PFS) and overall survival (OS) in PTL was significantly better when compared to AD (PFS 92.9 vs. 28.1 months, p &amp;lt; 0.0006; OS 108.7 vs. 56.7 months, p = 0.0002). Median PFS2 and OS2 since CNS relapse was dismal in AD compared to PTL (PFS2 1.6 vs. 37.8 months, p = 0.04 and OS2 2.3 vs. 37.8 months, p = 0.05). Conclusions: The rate of CNS relapses in PTL and advanced disease with testicular involvement is lower than previously reported. This study confirmed a significant favorable impact of rituximab in prevention of CNS relapse. Notably, methotrexate prophylaxis i.v. or i.t. did not alter the CNS relapse risk. Prognosis of CNS relapse is particularly poor in advanced disease. This work was supported by grant AZV NU21-03-00411 from the Ministry of Health of the Czech Republic and by the Cooperatio Program, research area “Oncology and Haematology”

Clinical Characteristics Analysis of Gastrointestinal Peripheral T-Cell Lymphoma:Impact of Non-Emergency Surgery on Overall Survival

Introduction The gastrointestinal tract is the most common extranodal site involved in non-Hodgkin lymphoma (NHL) and most NHL cases are of B-cell origin. Peripheral T-cell lymphoma (PTCLs) involving the gastrointestinal is less commont, comprising only about 4-6% of gastrointestinal lymphomas. This study retrospectively analyzed the clinical characteristics and potential clinical factors influencing survival outcomes in patients diagnosed with PTCLs through gastrointestinal tissue biopsy at our center. Methods Based on the clinical data, patients were reevaluated for clinical staging and risk stratification, including Ann Arbor staging, IPI scoring, and gastrointestinal lymphoma Lugano staging. Patient's follow-up was conducted through outpatient medical records and telephone communication. For the analysis of categorical data, the chi-square test or Fisher's exact test was used. Survival time was estimated using the Kaplan-Meier method. The Cox proportional hazards model was employed to calculate hazard ratios (HR) and their 95% confidence intervals (CI) to analyze prognostic factors. Data analysis was performed using SPSS 23 for Windows software. Results A total of 622 gastrointestinal tissue biopsy samples from October 2014 to September 2022 were retrieved from the medical records system. Among them, 67 cases (10.8%) were diagnosed as PTCLs. Among them, 5 cases had no available clinical data and were excluded. Detailed information regarding patient clinical characteristics can be found in the table. Treatment and Efficacy: Among the 62 patients with available clinical data, 43 received gastrointestinal surgical resection treatment, including 21 cases (33.9%) of elective non-emergency surgery and 22 cases (35.5%) of emergency surgery due to acute abdomen. The median courses of chemotheray was 5 (1~8). 15 patients (31.3%) achieved complete response (CR)/CRu; 10 patients (20.8%) achieved partial response (PR). Among the 59 patients who received chemotherapy and/or surgical treatment, progression-free survival (PFS) was evaluated with a median follow-up time of 48.4 months, and the median PFS was 4.4 months (95% CI: 2.5-6.3) (Figure). Multivariate analysis identified advanced Ann Arbor stage (stage 3/4) (HR=3.53, 95% CI: 1.53-8.17, P=0.003) as independent adverse prognostic factors for PFS. Receiving chemotherapy (HR=0.24, 95% CI: 0.09-0.66, P=0.005) and elective surgery (HR=0.45, 95% CI: 0.22-0.92, P=0.029) were identified as independent favorable prognostic factors for PFS. As of the last follow-up, a total of 49 patients (79.0%) had died and the median overall survival (OS) was 6.4 months (95% CI: 3.8-8.9) (Figure). Multivariate analysis identified Ann Arbor stages 3-4 (HR=3.01, 95% CI: 1.34-6.74, P=0.007) as an independent adverse prognostic factor for OS, and receiving chemotherapy (HR=0.13, 95% CI: 0.05-0.31, P&amp;lt;0.001), elective surgery (HR=0.36, 95% CI: 0.16-0.74, P=0.006) were identified as independent favorable prognostic factors for OS. Conclusion Data from four hematological disease treatment centers located in Zhejiang Province, southeastern China, showed that PTCLs involving the gastrointestinal tract accounted for approximately 10.8% (67/622) of all gastrointestinal lymphoma patients. These patients had a relatively high incidence of gastrointestinal perforation (35.5%). The overall treatment efficacy for patients was poor, with a majority of them succumbing to disease progression. The median PFS and OS were approximately six months. Elective surgery and chemotherapy appeared to improve the patients' outcomes.

Predictors and Timing of Venous Thromboembolism in Lymphoma

Introduction Cancer associated thrombosis (CAT) is common in lymphoma, but the risk is not well characterized. While prophylactic anticoagulation is recommended in certain solid tumors, routine prophylaxis is not practiced in hematologic malignancies. The Kohrana CAT risk score considers lymphoma a single entity. We aimed to identify the incidence rate of venous thromboembolism (VTE) and risk factors in lymphoma patients at our institution. Methods Patients diagnosed with lymphoma between 2018 and 2022 were identified through our institution's tumor registry. Using automated text search from our electronic medical record (EPIC®) combined with natural language processing review, VTE events were identified from 90 days before and up to one year(y) after initiation of chemotherapy initiation, or diagnosis date if no chemotherapy was administered. VTE events included lower extremity deep vein thrombosis (DVT) or pulmonary embolism (PE). Events were reviewed and adjudicated manually by us. We report time to event analysis and survival analysis using Kaplan-Meier curve. The study was censored at one year. Univariate and multivariate analyses were performed using COX-regression model. We evaluated the effect of indolent versus aggressive lymphoma, stage, age, sex, race, ethnicity, white blood cell count, hemoglobin, and platelet count. Results We identified 879 patients(pts) with lymphoma; of those, 378 pts had indolent lymphoma (I-Lym) and 501 pts had aggressive lymphoma (A-Lym). Median age was 61y. 464 pts (52.8%) were above 60 y, 477 pts (54.3%) were males, and 325 pts (37.0%) were Hispanic. Race was distributed as follows: 89.5% white, 9.1% Black, and 1.4% other. 56.9% had advanced stage lymphoma. VTE occurred in 4.9% (n=43) of the overall population within 12 months. The incidence was higher in A-Lym (7.2%, n=36) compared with I-Lym (1.9%, n=7), p&amp;lt;0.001. For both A-Lym and I-Lym, 32.6% of the VTE events occurred prior to diagnosis or initiation of chemotherapy. Among patients who developed thrombosis after the chemotherapy start date, the median time to thrombosis was 39 days. In a univariate analysis (Table 1) for thrombosis-free survival, age&amp;gt;60, receiving chemotherapy and A-Lym, were all associated with higher risk of thrombosis (p&amp;lt;0.05). In the multivariate analysis, only, age&amp;gt;60, and A-Lym remained significant in predicting thrombosis (HR: 3.48, 95%CI: 1.41, 8.61, p=0.007). Hemoglobin &amp;lt;10, platelet count &amp;gt;350, white blood cell count &amp;gt;11, advanced stage, and chemotherapy administration were not significant risks of thrombosis. In multivariate analysis for overall survival (Table 2), development of VTE was associated with increased risk of mortality (HR: 2.59, 95%CI: 1.38, 4.87, p=0.003). This relationship of VTE and mortality was observed independently in both I-Lym and A-Lym. As expected, A-Lym, age&amp;gt;60, male sex, and advanced stage all predicted worse survival in our lymphoma population (p&amp;lt;0.05 for all). Of note, hemoglobin &amp;lt;10 and white blood cell count &amp;gt;11, did not predict VTE in lymphoma but did predict poor OS. Conclusion Lymphoma is associated with a clinically relevant rate of CAT, but incidence is significantly higher in A-Lym compared with I-Lym with a third of events occurring prior to chemotherapy. The hematologic parameters of the Khorana Score (WBC, Hgb, platelet count) did not correlate with incidence of CAT in lymphoma, neither did chemotherapy. Development of CAT during therapy, in multivariate analysis for both A-Lym and I-Lym, was associated with a marked reduction in OS. These points suggest that the thrombotic risk is an inherent property of lymphoma biology in at least some cases, leading to an increased risk of CAT as well as reduced OS. We do not propose that CAT-related mortality is driving the reduced OS, but more likely a marker of poorer prognosis. Limitations: This was a single center/ single dataset and these findings should be considered a derivation cohort, and should be verified with independent additional datasets. If our findings are verified, prospective studies to assess benefit of prophylactic anticoagulation in aggressive lymphoma may be warranted.

Clinical study of mature B-cell lymphoma in 11 children with chromosome 11 long-arm abnormalities

Objective: To explore the clinical, pathological, diagnostic, treatment, and prognostic features of children with mature B-cell lymphoma (MBCL) . Methods: This retrospective study included pediatric patients with MBCL with chromosome 11 long-arm abnormalities who were diagnosed and treated at our hospital from December 2018 to February 2023. Results: Among the 11 pediatric patients with MBCL, nine were male and two were female, with a median age of 9 (2-13) years and a median disease course of 1.8 (0.5-24) months. The clinical manifestations were cervical lymph node enlargement in four patients, nasal congestion and snoring in four patients, abdominal pain in two patients, and difficulty breathing in one patient. There were seven cases of Burkitt's lymphoma, two of follicular lymphoma, and two of advanced B-cell lymphoma according to the pathological morphology examination. No patients had central nervous system or bone marrow involvement, and no extensive metastasis was observed on B-ultrasound or positron emission tomography-computed tomography (PET/CT). One patient had a huge tumor lesion. The Revised International Pediatric Non-Hodgkin Lymphoma Staging System classified four patients as stage Ⅱ, five as stage Ⅲ, and two as stage Ⅳ. 11q probe detection showed five cases of 11q gain, three of 11q loss, and three of both gain and loss. FISH showed positive MYC expression in three patients, including eight with advanced B-cell lymphoma with 11q abnormalities and three with Burkitt's lymphoma with 11q abnormalities. According to the 2019 edition of the National Health Commission's diagnostic and treatment guidelines for invasive MBCL in children, one patient was classified as Group A, two as Group B, and eight as Group C. Early evaluation of the efficacy showed complete remission. After mid-term evaluation, the intensity of chemotherapy was reduced in Group B and Group C. Among two cases of chemotherapy, the remaining nine cases had a median follow-up of 32 (6-45) months, and none had event-related survival. Conclusion: The incidence of MBCL with 11q abnormalities in children is low, clinical symptoms are mild, and progression is slow. The absence of MYC, BCL2, BCL6 rearrangements, C-MYC negative and 11q abnormalities on FISH is an important diagnostic indicator, and reducing the intensity of chemotherapy can improve prognosis.

The role of FDG-PET scanning and PET-adapted therapy in the primary treatment of Hodgkin lymphoma: A primer for clinicians

The evolving treatment paradigm for classical Hodgkin lymphoma (cHL) remains focused on maintaining high rates of progression-free survival (PFS) and overall survival (OS), while seeking to reduce both short-term and late toxicities from chemotherapy and radiation. Functional imaging with fluoro-deoxyglucose (FDG)‑positron emission tomography (PET) combined with computed tomography (CT) is recognized as standard for staging and response evaluation of Hodgkin lymphoma (HL). Recent randomized controlled trials evaluating FDG-PET-guided therapy for patients with limited stage and advanced stage Hodgkin lymphoma provide clinicians and patients with meaningful data upon which to base individualized treatment approaches. FDG‑PET scanning after two cycles of therapy (interim PET or PET2) represents the most important determinant of further appropriate treatment and subsequent outcomes, and is now the cornerstone of risk-adapted therapy for all patients receiving curative-intent initial therapy for Hodgkin lymphoma. For patients with limited stage cHL, post-chemotherapy assessment (after two or four cycles of treatment depending on the regimen used) is also a key determinant of the need for the addition of involved site or nodal radiation as part of combined modality therapy. This review summarizes the important role of interim and end of chemotherapy FDG-PET scanning to guide individualized initial therapy for patients to achieve optimal treatment outcomes.

Health Insurance Continuity Is Associated with Stage at Diagnosis Among Children, Adolescents, and Young Adults Newly Diagnosed with Lymphoma

Background: Many uninsured patients do not gain Medicaid coverage until the point of, or after, their cancer diagnosis, which can limit access to early cancer detection and delay diagnosis and treatment, leading to poorer survival outcomes. Our previous research found that gaining Medicaid at, or after, diagnosis (vs. continuous Medicaid coverage) is significantly associated with inferior survival among children and adolescents/young adults (AYAs) with lymphoma, a leading cause of pediatric and AYA cancers. However, whether this relationship is mediated by lymphoma stage at diagnosis is unknown. To fill this knowledge gap, the current study examines the association between Medicaid coverage continuity and disease stage among this vulnerable population. Methods: We identified 13,655 children and AYAs (ages 0-39 years) newly diagnosed with lymphoma between 2007-2012, using the linked Surveillance, Epidemiology, and End Results (SEER) registries and Medicaid enrollment data. To measure coverage continuity, we categorized patients into those with 1) continuous Medicaid (enrolled in Medicaid for ≥12 months prior to and through diagnosis), 2) newly gained Medicaid (enrolled in the month of or within 12 months after diagnosis), 3) other patterns of noncontinuous Medicaid, 4) private insurance at diagnosis, 5) other insurance types at diagnosis (Medicare, TRICARE, Military, VA, or Indian/Public Health Service), and 6) unknown or no insurance at diagnosis. The last 3 groups comprised patients not linked to Medicaid enrollment data; thus their insurance continuity patterns were unknown, and their insurance status at the time of diagnosis was extracted from SEER registries. The association between coverage continuity and late-stage diagnosis was examined with separate multivariable logistic regression models among all patients and by cancer subtypes (Hodgkin lymphoma, non-Hodgkin lymphoma). Late-stage was defined as stage IV (vs. stage I-III) using the Ann-Arbor staging classification. Regressions also adjusted for sex, race/ethnicity, age at diagnosis, diagnosis year, rurality, neighborhood socioeconomic status (SES), and state of residence. Results: Half of our sample had private insurance (50.3%), followed by Medicaid insurance (26.9%), other insurance type (10.3%), and unknown (7.9%) or no insurance (4.7%). Among Medicaid-insured patients, 40.1% had newly gained Medicaid, followed by continuous Medicaid (32.5%) and other patterns of noncontinuous Medicaid (27.3%). Overall, one-fourth (24.8%) of the sample had stage IV lymphoma (Figure 1). Compared with privately insured patients, the adjusted percentage of stage IV diagnoses was 16.8 percentage points (ppt; 95% CI=14.6-19.0, p&amp;lt;0.001), 10.6 ppt (95% CI=8.2-13.0, p&amp;lt;0.001), and 4.9 ppt (95% CI=2.7-7.1, p&amp;lt;0.001) higher in patients with newly gained Medicaid, other patterns of noncontinuous Medicaid, and continuous Medicaid, respectively. Among the subset of Medicaid-insured patients, the adjusted percentage of stage IV diagnoses was 10.7 ppt (95% CI=7.5-13.8, p&amp;lt;0.001) and 5.4 ppt (95% CI=3.1-7.6, p&amp;lt;0.001) higher among patients with newly gained Medicaid and other patterns of noncontinuous Medicaid, respectively, compared to those with continuous Medicaid. These patterns persisted across lymphoma subtypes. Notably, coverage continuity patterns varied by sociodemographic factors, with non-Hispanic Black (vs. non-Hispanic White) patients, AYAs ages 15-39 years (vs. pediatric patients ages ≤14), and residents of non-metropolitan (vs. metropolitan) areas or lower SES neighborhoods significantly more likely to have newly gained Medicaid. Conclusions: Less than one-third of Medicaid-insured children and AYAs with lymphoma had continuous insurance coverage prior to cancer diagnosis. Lacking continuous Medicaid coverage was significantly associated with advanced-stage lymphoma diagnosis.