Concurrent Sessions

3:30 – 4:30 pm Thursday, September 13

Going Viral: Review of Viral Illness and Antiviral Therapy in Hematopoietic Stem Cell Transplant Pediatric Patients (200)

1CNE  Hematopoietic stem cell transplant (HSCT) recipients are at significant risk for developing serious and sometimes fatal infectious complications. Common viral infections post-transplant occur from reactivation of a dormant virus, including herpes simplex (HSV), Varicella (VZV), cytomegalovirus (CMV), BK virus and Ebstein Barr Virus (EBV). Immunocompromised patients may also experience significant morbidity and mortality from common respiratory viruses, such as influenza, parainfluenza, adenovirus, and respiratory syncytial virus (RSV). Interventions vary greatly and can include prophylaxis, preemptive therapy or treatment of active infection. A variety of antiviral agents are now used including cellular immune therapy. A pharmacologic review will show that antiviral agents often have different dosage schemes, complex side effect profiles, and the need for supportive care.

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3:30 – 4:30 pm Thursday, September 13

Introduction to Radiation Therapy: What Should a Nurse Know? (202)

1CNE  Radiation therapy is an integral component of the overall management for many children with cancer. Better understanding of radiation therapy will improve the ability of nurses and advanced practice providers to care for these children. Review will include the underlying mechanisms of radiation in treating cancer and provide an overview of the common clinical indications for radiation. The presentation will provide an overview of the radiation planning and treatment process including dosing and fields using several case studies of children with different diagnoses. Common acute toxicities and management approach will be covered. Finally, common late effects and recommended follow-up care will be discussed. Read more...
3:30 – 4:30 pm Thursday, September 13

Putting the Horse before the CAR–T! Educating Nurses on Algorithms to Recognize Cytokine Release Syndrome and CAR–T Related Encephalopathy Syndrome (203)

1CNE  Chimeric antigen receptor (CAR) therapies, recently approved by the U.S. Food and Drug Administration (FDA) for the treatment of hematologic malignancies in pediatric and adult populations, offer remarkable promise for patients with previously treated-refractory disease. Kymriah™, the first FDA-approved agent for the treatment of children and young adults up to 25 years of age with relapsed or refractory B–cell acute lymphoblastic leukemia, demonstrates an overall remission rates 83%. Significant, potentially life-threatening toxicities accompany these promising outcomes, most notably cytokine release syndrome (CRS) and CAR–related encephalopathy syndrome (CRES). Early identification and strategic management of symptoms are critical to support positive patient outcomes. An interprofessional team developed evidence-based algorithms for the diagnosis and management of CAR therapy-related toxicities.

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3:30 – 4:30 pm Thursday, September 13

Are Your Patients with Advanced Cancer Suffering? A Nurse-Led Study Utilizing Technology to Measure Symptoms (C205)

coglogo1CNE  Nurses and nurse practitioners have the opportunity to be at the forefront of supportive care research using current technology. Through collaboration between the COG Nursing Research Subcommittee and Alex’s Lemonade Stand Foundation, a mentored nursing grant funded a multisite study investigating how children with advanced cancer experience symptoms. Minimizing suffering, including effective symptom management, in children with advanced cancer is a central value for pediatric oncology clinicians (Nuss et al., 2005). Patient-reported outcomes have been used in pediatric oncology symptom-related research (Baggot et al., 2012); however the majority of literature specific to symptoms during palliative or end-of-life care for children with advanced cancer is based upon medical record reviews and to a lesser extent, patient self–report (Hinds et al., 2007; Wolfe et al, 2015). The study purpose was to prospectively describe symptom frequency, severity, and distress level in children and adolescents with advanced cancer using patient self-report and parent proxy.

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4:45 – 5:45 pm Thursday, September 13

Pediatric Cancer Predisposition: What the Clinician Needs to Know (206)

1CNE  Precision medicine has emerged with the advancement of genetic technologies and knowledge of molecular pathogenesis. A clinical translation of precision medicine in pediatric oncology lies in hereditary cancer predisposition syndromes, which plague approximately 10% of patients and families. Proper identification of these patients, appropriate genetic testing and counseling, and an understanding of short-term treatment implications and long-term screening protocols are all essential to comprehensive care for patients and families with cancer predisposition syndromes. Current knowledge of pediatric cancer predisposition syndromes, referral and identification, and treatment and long-term follow up will be discussed. Moreover, a case series and easy reference tools for clinical practice will be presented.

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4:45 – 5:45 pm Thursday, September 13

Iron Overload: Implications in Hematology, Oncology, and HSCT Patients (207)

1CNE Iron is a vital mineral which is essential for life. Humans obtain iron through ingestion in foods where absorption is tightly regulated. Iron is bound to transferrin for transport due to the ability of labile plasma iron to cause oxidative damage to tissues and organs. Iron loss occurs through desquamation of the small intestine and menses in women and equals 1–2 mg Fe/day, similar to absorption. Blood transfusions are a lifesaving therapy for hematology patients as well as oncology and hematopoietic stem cell transplantation (HSCT) patients. Anemia, a common side effect of cancer and chemotherapy, used to be treated with erythropoietin stimulators until concerns were raised about their effect on tumor growth. Blood transfusions are a safe, readily available method to increase patient’s hemoglobin and can be done easily in the outpatient setting. However, each unit of blood contains 200–250 mg of iron which is released as the transfused blood cells break down.

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4:45 – 5:45 pm Thursday, September 13

DNR, DNET, DNI: The Alphabet Soup of Resuscitation (208)

1CNE  Caring for infants, children, adolescents, and young adults through the end of life is challenging. "Getting the DNR" is terminology that many nurses are used to hearing; they may even be the ones asking for clarification of "code status" as their patients come closer to the end of their lives. This presentation will clarify definitions and abbreviations commonly used including DNR, AND, and DNET, and the meaning these terms have for the hematology/oncology team, patients, and families. How we talk with families will be reviewed, including discussions of data, what we are not going to do, and asking them to make impossible decisions. Finally, suggestions for discussing goals of care and recommendation and the role of hope will be discussed and practiced.

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4:45 – 5:45 pm Thursday, September 13

Low Dose Ketamine Use in the Non-ICU Setting for Pediatric Hematology and Oncology Pain (209)

1CNE  Managing severe pain in children, adolescents, and young adults with oncologic malignancies and sickle cell disease present a challenge to members of the multidisciplinary team. Traditional pain treatment strategies rely primarily on opioid analgesia (Wang, 2015) in addition to complementary therapies to provide comfort. Despite these interventions, many patients report inadequate pain control and adverse effects. These side effects can range from tolerable (pruritis) and dose-dependent (constipation) to life-threatening (respiratory depression, sedation). Refractory pain is a common reason for hospital readmission in this patient population, specifically in patients with sickle cell disease or patients being treated at the end of life. Ketamine, a dissociative anesthetic used for sedation, has traditionally been administered in the operating room or in an intensive care unit (ICU) setting with stringent monitoring parameters. In patients with persistent pain despite traditional analgesic interventions, adjuvant therapy with low-dose ketamine infusions have proven beneficial (Hagedorn, 2016). Low-dose ketamine infusions are associated with opioid-sparing effects, improved pain management, and improvement in the child's ability to interact with their family (Finkel, 2007).

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4:45 –5:45 pm Thursday, September 13

A Tale of Two MABs: Blinatumomab and Inotuzumab in COG Clinical Trials for Relapsed B ALL (C211)

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1CNE  Survival for pediatric patients with relapsed B lineage acute lymphoblastic leukemia (ALL) is sub-optimal. Traditionally, treatment protocols for relapsed ALL have relied on cytotoxic chemotherapy. Despite substantial acute and long-term toxicity, there has been no significant improvement in survival in patients treated on these protocols over the past several decades. Chemoresistance is commonly cited as a reason for treatment failure. Treatment failure is defined as either the inability to achieve clinical remission post-relapse or a subsequent relapse following traditional therapy that includes intensified chemotherapy with or without stem cell transplant. The ideal therapy would be the use of a cellular targeted approach that destroys leukemia cells but spares other cells and improves response and survival while minimizing distressing and sometimes life-threatening toxicities. Early phase clinical trials with the synthetic antibodies Blinatumomab (BiTE) and Inotuzumab (INO) have shown great promise in achieving clinical response in heavily pre-treated pediatric and adult patients with relapsed and refractory ALL. This session will detail the targeted approach of these novel antibodies and their unique mechanisms of action: Blinatumomab modulates the immune system to destroy cancer cells, while Inotuzumab provides a link to deliver cytotoxic treatment directly to the cancer cell. These two novel agents will be compared, including their reported efficacy from early phase trials, toxicity profiles, and administration principles. Highlights from the current COG clinical trials AALL1331 and AALL1621 will be reviewed, with a focus on the uniqueness of each trial, including phase type and eligibility criteria. Additionally, AALL1331 has been activated since December 2014, providing an opportunity to share clinical examples and practical tips regarding the nursing care of patients receiving Blinatumomab.

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3:30 – 4:30 pm Thursday, September 13

Management of Retinoblastoma in 2018: A Nursing Perspective (201)

1CNE  Retinoblastoma (RB) is the most common primary ocular malignancy of young children. Approximately 8,000 children are diagnosed with RB worldwide annually. If caught early RB can be cured, preserving life, vision, and the eye(s). At our institution, the treatment of retinoblastoma has evolved dramatically over the past decade. Utilization of focal therapies has transformed our treatment algorithms, patient outcomes and nursing care; our RB overall survival exceeds international rates. Localized treatments include chemotherapy administered directly into the eye via the ophthalmic artery or intra-vitreously, laser photocoagulation, cryotherapy, and, in cases of very advanced eyes, plaque brachytherapy or enucleation.

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