Displaying items by tag: Intermediate Level

2:15 – 3:15 pm Saturday, September 15

DSRCT: A Pediatric Oncology Rarity (230)

1CNE  Desmoplastic small round cell tumor (DSRCT) is one of the rarest pediatric tumors and was only recently classified in 1989. Categorized under sarcomas, DSRCT under the microscopic is a fusion of a both a wilms and ewing sarcoma gene. Although known as a mostly surgical tumor, chemotherapy, radiation, and new treatments like immunotherapy are vital in the battle against this fatal disease. DSRCT is known mostly in the adolescent and young adult population, where the rate of occurrence is predominantly in males. In a retrospective cohort analysis published in 2014 from the Journal of Cancer Epidemiology, the 5-year survival rate was found to be just 33.3% (Lettieri, Garcia-Filion, Hingorani, 2014). Factors impacting survival rate are the overall oncology role to treatment and management.

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11:30 am – 12:30 pm Saturday, September 15

Therapeutic & Prognostic Impact of Medulloblastoma Molecular Subgroups (227)

1CNE  Medulloblastoma is an embryonal tumor of the central nervous system (CNS). It is the most common malignant CNS tumor in children with peak incidence between 5–9 years of age. Patients typically present with cerebellar deficits and headaches with vomiting, specifically in the mornings. Prognosis varies according to multiple factors including histology, age at diagnosis, and metastases. Medulloblastoma treatment is an intense, multi-modality therapy that can have many resulting late effects. Recent findings have shown medulloblastoma to be a heterogeneous disease which includes multiple subgroups.

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11:30 am – 12:30 pm Saturday, September 15

Comprehensive Care for Thalassemia (226)

1CNE  Thalassemia is becoming a more common diagnosis seen in pediatric hematology/oncology centers. The term thalassemia describes a group of very complex diseases that requires thorough, comprehensive care to improve outcomes and quality of life for these patients. A complicating factor is that patients often are immigrants or refugees with language and cultural barriers and other socioeconomic issues. The care of these patients require a multidisciplinary approach and a strong understanding of the pathophysiology, specific complications, current treatments, and new and emerging therapies.

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3:15 – 4:15 pm Friday, September 14

Beyond the Cure: The Children’s Oncology Group’s Efforts to Improve Outcomes for Pediatric Cancer Patients Long after Treatment has Finished (C223)

coglogo1CNE  Childhood cancer survivors are living longer than ever before, with overall survival rates exceeding 80%. As a result, survivors also are living with chronic late health effects related to their curative treatments, with 40% of survivors experiencing a severe, disabling, and life-threatening or fatal late effect at 30 years post-treatment. Late effects may include second malignancies, endocrinopathies, cardiomyopathy, infertility, pulmonary function deficits, renal/ocular/auditory disorders, neurocognitive deficits, and metabolic syndrome. Recent studies report that cumulative incidence of late effects may be even higher than previously reported, with survivors having 3 to 5 treatment-related chronic health conditions by the age of 50.

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3:15 – 4:15 pm Friday, September 14

Running on Empty: Inherited Bone Marrow Failure (219)

1CNE Inherited bone marrow failure syndromes are a diverse group of hematologic disorders. Despite the name, some children have new, not inherited, genetic mutations. These mutations can result in congenital abnormalities or disease in specific organs or increased cancer predisposition. Through a series of patient vignettes we will follow six patients with common syndromes highlighting clinical presentation, diagnostic evaluation, and evidence-based treatment and monitoring recommendations. We also will explore the impact of a genetic diagnosis on the psychological and social well-being of families as the parents grapple with the decision whether to pursue genetic testing for themselves or their other children.

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11:00 am – Noon Friday, September 14

High Risk Therapy Made Easy: Supporting High Risk Patients Through Complex Therapy (215)

1CNE  High risk (HR) pediatric oncology patients continue to undergo new and emerging treatment protocols, which have multiple complications that patients may encounter. Accurate assessment and early interventions is key to supporting patients through therapy. This session will focus on supportive cares for relapse leukemia and HR neuroblastoma patients; with special focus on the immunotherapy drugs blinatumomab and dinutuximab as well as infection prophylaxis. Most frequent serious adverse events noted in patients treated with blinatumomab are disorders of the nervous system and systemic cytokine release syndrome (CRS). Events are usually reversible and able to be managed with attentive supportive care. Most frequent side effects noted in patient treated with dinutuximab are pain, hypersensitivity reactions, CRS, capillary leak, fevers, and hypotension. We will use case studies of HR patients.

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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 – 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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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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Integrative Medicine in Pediatric and Adolescent Oncology: An Overview for the Nurse and Nurse Practitioner (008)

3.25CNE  The journey through cancer therapy is complex. While no two patients experience it the same way, there are predictable similarities when considering patient age, diagnosis, and therapy that is administered. Common problems encountered by many patients include diminished energy and physical stamina, neuropathy, disturbed sleep, poor appetite, weight loss, and exaggerated nausea.

Integrative medicine combines mainstream medical therapies with complementary therapies for which there is high quality scientific evidence of safety and effectiveness. In the setting of active treatment for children and adolescents with cancer, it consists primarily of complementary therapies intended to support general health or to limit specific treatment related toxicity. Numerous modalities may fall within this category, including dietary modification, nutrient and botanical supplements or applications, guided imagery, aromatherapy, acupuncture, and massage. It is estimated that 30–70% of pediatric patients use integrative medicine strategies; since this is by parental report, many studies likely underestimate their use.

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