Infant ALL: Rearranged for the Big Screen! Providing Care on COG AALL15P1, Nurses in a Leading Role! (C211)

5:00–6:00 pm Thursday, September 5

coglogoAcute lymphoblastic leukemia (ALL) is the most common pediatric malignancy, with 5-year overall survival rates exceeding 90% (Hunger, Lu, Devidas, Camitta, Gaynon, Winick, 2012). Unfortunately, infants with ALL are an exception to the improving survival trends and remain one of the most challenging populations in pediatric hematology/oncology (Kotecha, Gottardo, Kees, Cole, 2014).

Seventy-five to eighty percent of infant ALL cases have cytogenetic abnormalities involving the mixed lineage leukemia (MLL) gene at chromosome 11q23, now referred to as KMT2A-Rearrangement (KMT2A-R). Infants with KMT2A-R ALL typically present with aggressive disease and have a poor prognosis despite intensive chemotherapy and stem cell transplantation, with 5-year event-free survival rates of 37%-47% (Dreyer, Hilden, Jones, et al 2015). Their vulnerability to complications and toxicity make the care of infants with ALL especially challenging. Relapse frequently occurs early, and the second remission is difficult to achieve, indicating that chemoresistance is a significant obstacle (Brown, 2013).Novel treatments are necessary to improve rates of sustained first remission and overall survival. Azacitidine is a DNA methyltransferase inhibitor (DNMTi) that has been used in adult and pediatric acute myeloid leukemia (AML) and ALL and shown to be both safe and well-tolerated in children (COG AALL15P1). The Children’s Oncology Group trial AALL15P1 is currently testing the addition of azacitidine to chemotherapy in infants with ALL who have KMT2A gene rearrangement. The protocol includes supportive care guidelines shown to improve outcomes, particularly for high-risk patients receiving very intensive therapy. Nurses play a critical role in caring for these infants while fostering normal infant development, as these patients spend months in the hospital, often unwell, and are at high risk for developmental delays. This session will review the evolution of treatment for infant ALL, identify treatment-related complications, and review supportive care and developmental strategies integral to the nursing care of infants with ALL.