Clinician-to-Clinician Update Clinician-to-Clinician Update

Forging New Paths in Pediatric Leukemia and Lymphoma Care

November 2014

As of 2014, on average 1 in 285 children in the United States will be diagnosed with cancer before age 20 years, and approximately 38% of the diagnoses will be leukemia or lymphoma.1 Treatment standards for pediatric leukemia and lymphoma have made striking gains during the last 40 years. For example, the 5-year survival rate for patients with acute lymphoblastic leukemia has increased from 57% between 1975 and 1979 to 90% between 2003 and 2009. 1 A critical part of this success has been the community’s commitment to research, including both basic scientific research as well as clinical trials.

As hematology/oncology specialists at University of Minnesota Masonic Children’s Hospital, as well as faculty in the Department of Pediatrics, we play a major role in both basic and clinical research. We have a fundamental commitment to improving outcomes — combining our academic and research backgrounds with determination and passion toward our goal of curing cancer and disease, not only in our patients, but in all children. Numerous national grants have been awarded to physicians in our division to perform leading-edge research on topics such as the prognostic potential of biomarkers in blood at presentation and after 1 month of chemotherapy; conjugated gold nanoparticles as a treatment for leukemia and lymphoma; and novel small molecule therapeutics for patients with refractory leukemia. These research efforts are led by Drs. Peter Gordon and Lucie Turcotte, new recruits in the division.

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97% of our patients would recommend us to family and friends.

In addition, our division is the only member of the National Cancer Institute-funded, Children’s Oncology Group (COG) Phase 1 & Pilot Consortium in Minnesota, and our division director, Brenda Weigel, MD, MSc, is the National Chair for the Phase I Consortium. The Consortium is comprised of 21 premier pediatric oncology programs in the United States that were selected through a peer review process. Through membership in this program, we are able to offer your patients access to more clinical trials than any other children’s hospital in the state.

Our participation in research and clinical trials is not just limited to the treatment of newly diagnosed and relapsed disease. We also are heavily focused on investigating and minimizing the long-term health impact of childhood cancer treatment. There is evidence that adult survivors of hematological cancer have increased risk for the metabolic syndrome.2 Lucie Turcotte, MD, is conducting a clinical study to evaluate risk factors for metabolic syndrome in childhood cancer survivors. This comprehensive study combines clinical data with circulating biomarker testing for the presence and function of certain immune cells, as well as adipokines and certain cytokines. By comparing these factors between hematological cancer survivors and healthy controls, she is leading the way to identifying risk factors that may impact the long-term quality of life for survivors of childhood leukemia and lymphoma.

References

1. Ward E, DeSantis C, Robbins A, Kohler B, Jemal A. Childhood and adolescent cancer statistics, 2014. CA Cancer J Clin. 2014;64(2):83-103.

2. Gan HW, Spoudeas HA. Long-term follow-up of survivors of childhood cancer (SIGN Clinical Guideline 132). Arch Dis Child Educ Pract Ed. 2014; 99(4):138-143.

When to refer

When working up a pediatric patient for a possible hematological malignancy, it is very important to have a low threshold for referral. We encourage referring physicians to contact us early in the process, even when simply ruling out a malignancy, as early diagnosis is key to optimizing patient outcomes.

Once we have partnered with you in caring for your patient, we are committed to working with you to provide care as close to home as possible. In some cases, outpatient and even inpatient chemotherapy can be administered at local centers, sparing patients and their families travel time and expense. We have outreach clinics in Maple Grove, Minn., Rapid City and Sioux Falls, S.D., and partner with colleagues in Duluth, Minn. and Fargo and Bismarck, N.D.

Please contact us at any time with questions about your patients. Physician Referrals: 888-KIDS-UMN (888-543-7866)

Collaborative Care

We are committed to a collaborative approach to cancer care. We welcome the opportunity to discuss patient cases and provide evidence-based advice about treatment choices with referring physicians. We can provide consultations focused on the latest treatments, eligibility for clinical trials, and multidisciplinary approaches to care. The division also works seamlessly with the Blood and Marrow Transplant team for patients in which transplant is indicated.

Our commitment to collaboration with referring physicians is also reflected in our in-program commitment to multidisciplinary care. For example, the Comprehensive Leukemia and Lymphoma Clinic facilitates communication between the care team and reduces the burden of multiple appointments on patients and families. In the Comprehensive Clinic, pediatric patients with leukemia and lymphoma are seen by our oncology physicians and program-dedicated nurse practitioners, followed by appointments with a physical therapist, nutritionist, neuropsychologist, dentist, and a program-dedicated social worker, or other specialists, as needed—all on one afternoon in one location!

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