CCBD: Children's Leukemia/Lymphoma Service

Leukemia/Lymphoma

Leukemia is the most common childhood malignancy, with approximately 3,000 new cases diagnosed in the United States each year. The Center for Cancer and Blood Disorders (CCBD) is the largest center for pediatric oncology in the central United States, north of Houston and west of Chicago and Memphis. The CCBD ranks among the top 5 percent of the 230 Children's Oncology Group (COG) member institutions in the availability of cancer treatment protocols and enrollment of eligible children on the experimental treatments. The COG is world's largest cooperative cancer research organization.

The CCBD participates in the design and administration of clinical trials for children with leukemia through the COG. The CCBD has also been chosen by COG and the National Cancer Institute as one of the 20 Phase I Contract Institutions in the United States and Canada. This affords Children's Medical Center the opportunity to offer new drugs to children when standard therapies have failed. It also provides new therapies for specific groups of children at the time or their initial diagnosis (see below).

Program Highlights/Research

• From January 1, 2007 to January 1, 2008, 78 children were newly diagnosed and treated for leukemia or lymphoma in the CCBD.
• The majority of patients were enrolled on clinical research protocols, providing invaluable information for development of future treatment strategies.
• As a pilot institution, Children's have several trials open for patients at the time of first diagnosis. Two examples: 1) A trial for patients with newly diagnosed high risk B-precursor leukemia that uses a new formulation of an important anti-leukemia drug, PEG asparaginase. This new formulation has enhanced stability and may be associated with a decrease in allergic reactions. Thankfully, the new form can be given intravenously. The older preparation must be given as a painful intramuscular injection. 2) A trial for infants with leukemia. These patients have typically had a poor prognosis, with projected cure rates of less than 40 percent. Through the Phase I consortium, Children's is enrolling infants on a treatment protocol that includes a novel agent that targets the genetic abnormality common to infant leukemias.
• Three institutional studies have been initiated; a trial designed to define the role of diffusion tensor imaging (a new application of MRI technology) in predicting neurologic toxicity in children with leukemia; a study designed to determine the role that mildly elevated blood sugars may play in the development of infections in children with leukemia; and, a trial that will establish whether or not there is a risk of heart damage associated with the delivery of very low doses of anthracyclines to children with leukemia.

Personnel

The CCBD includes 23 full-time faculty members.

Naomi Winick, M.D.
Dr. Winick. served as the vice-chair for clinical trials for the Acute Lymphoblastic Leukemia (ALL) Committee of COG during the inaugural grant period for the COG and now serves as the Chair of the Outcomes subcommittee of the COG ALL committee. She was the national protocol coordinator for the recently closed COG standard-risk ALL study and is the study chair for the current trial designed to enhance understanding of the neurocognitive toxicities that may accompany therapy for ALL. She also serves on COG's Developmental Therapeutics Committee.

Tamara Slone, M.D.
Dr. Slone is also a recent addition to our faculty; she has been selected to participate in the three-year long Clinical Scholars Training Program. She is devoted to doing clinical research in leukemia, with two of her current projects described above. The work Dr. Slone is performing on the impact of hyperglycemia on outcome among children with ALL was chosen for discussion the Clinical Research Training Institute, sponsored by the American Society of Hematology, and is funded through the American Society of Clinical Oncology. Her future work will likely focus on glucose regulation in patients with leukemia, as well as COG clinical trials. Dr. Slone is one of a small group of young investigators working with the current ALL executive committee on the development of future therapeutic studies.