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.

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)


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.

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.

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.

4:10 – 4:30 pm Thursday, September 13

Paper Presentation: Supporting Parents Across the Treatment Continuum — Adding a Parent to the Brain Tumor Team: Evaluation of Peer Support Intervention for Parents of Children with Brain Tumors (204-3)

1CNE  The physical and neurocognitive symptoms of childhood brain tumors present profound challenges to patients and families. Parents and caregivers of children diagnosed with brain tumors experience numerous stressors due to the complexities and uncertainties associated with treatment, long-term effects, and risk of relapse (Hutchinson, Willard, Hardy, & Bonner, 2009). To address these challenges, the California Chapter of the Pediatric Brain Tumor Foundation provides hospital-based support to parents of children with brain tumors from a Veteran Parent (VP). A mixed-methods, cross-sectional study was designed to evaluate the effectiveness of this intervention utilizing validated tools to compare parental resilience and impact of illness on the family between parents who met with the VP and those who did not.

3:50 – 4:10 pm Thursday, September 13

Paper Presentation: Supporting Parents Across the Treatment Continuum — Change in Genetic Knowledge of Parents Consenting to Clinical Genomic Sequencing for their Child with Cancer Following a Two-Phase Consent (204-2)

1CNE  Basis of inquiry: During informed consent, providers often present information in a complicated manner and may not differentiate between standard cancer treatment and the research objectives of a clinical trial. While clinical genomic sequencing is complex, it is important to understand how parental genetic knowledge may influence future decisions, including study participation and comprehension of test results. To increase parental understanding, this study utilized a two-phase consent process.

Purpose/Objectives: Evaluate change in parental genetic knowledge at the completion of a two-phase consent process.

3:30 – 3:50 pm Thursday, September 13

Paper Presentation: Supporting Parents Across the Treatment Continuum — Reasons, Hopes, Risks, Expectations: Qualitative Interviews of Parents Consenting to Genomic Sequencing for their Child (204-1)

1CNE  Basis of inquiry: Genomic sequencing is rapidly being incorporated into care for patients diagnosed with cancer. Little is known about why parents of children with cancer consent to sequencing and how they understand and weigh the risks, benefits, and uncertainty inherent in testing.

Purpose/Objectives: This qualitative inquiry was part of the Genomes 4 Kids study which included somatic and germline sequencing in a cohort of 301 prospectively identified pediatric oncology patients with leukemias, central nervous system (CNS), or non-CNS solid tumors treated at St. Jude Children’s Research Hospital. The aims of this aspect of the study were to identify reasons for participation given by parents enrolled in the larger study and perceived risks, benefits, expectations, and hopes.

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