Background: Pediatric non-Hodgkin lymphoma (NHL) is a heterogeneous malignancy with variable outcomes. Adenosine deaminase (ADA), a key enzyme in purine metabolism, has been implicated in tumor progression and immune evasion, yet its role in pediatric NHL remains underexplored. Methods: This retrospective study included 215 pediatric NHL patients categorized into precursor cell lymphoma (n = 88) and mature cell lymphoma (n = 127) groups based on pathology. Patients were further defined into good (n = 143) and poor prognosis (n = 72) groups according to international response criteria. Serum ADA and other laboratory parameters were measured at diagnosis. Results: Precursor cell lymphomas showed higher rates of bone marrow involvement, peripheral blood involvement, and clinical stage IV disease compared to mature cell lymphomas. ADA levels were significantly elevated in precursor cell lymphomas and in the poor prognosis group. Elevated ADA was strongly correlated with a poor prognosis. Multivariable analysis identified precursor cell lymphoma, fever, bone marrow involvement, elevated LDH, and elevated ADA as independent predictors of poor prognosis (all p < 0.05). Conclusions: Serum ADA is significantly elevated in pediatric NHL, particularly in precursor cell subtypes and poor prognosis cases, and serves as a potential prognostic marker. ADA may help improve risk stratification and guide personalized treatment strategies.
Zhu et al. (2026) studied this question.