Linsey Nuquist

Per.2B
January 9, 2015
Clinical trials for pediatric oncology patients
Pediatric oncology is normally a very sensitive topic for most to converse about. But in
the recent years there has been some especially great breakthroughs in the treatment of pediatric
oncology. With the help of many case studies and clinical trials there has been a staggering
amount of information and research developed that has brought the oncology world to a whole
new way of treatment. Not only are there new medicines to help the fight against cancer there are
new ways of delivering the meds to certain parts of the body there are more advanced ways to
aggressively treat cancer and the number of 5 year survivors only goes up year to year. Pediatric
cancer in particular is an aggressive beast in most cases but the amount of children that are
disease free 5 years later is an astonishing accomplishment. With the work of clinical trials they
are able to discover so much they didnt know about the disease and treatments for it.
Treatment of Burkitts/Burkitts-like lymphoma in adolescents and adults: a 20- year
experience for the Norwegian Radium Hospital with the use of three successive regiments. The
research for this article was done in Norway at the Norwegian Radium Hospital 1982- 2001. The
doctors that conducted this study were looking to find out if high dose therapy and stem cell
support was given to 49 patients aged 15-70 would it make a difference in the treatment of
cancer. A bit of background on the disease includes Burkitts/ Burkitts-like lymphoma
(BL/BLL) are highly aggressive B-cell lymphomas that most commonly affect children,
adolescents and young adults. Left untreated, the disease is rapidly fatal (Deparments of
medical oncology and pathology). The study was conducted over a 20 year period. The patients
we given to obtain durable remissions, high dose therapy with autologous stem cell support.
(Deparments of medical oncology and pathology). Also several groups have obtained
impressive results for BL- and B-cell acute lymphoblastic leukemia patients by giving blocks of

intensified chemotherapy for five to seven consecutive days with 2- to 3- week intervals.
(Deparments of medical oncology and pathology). In the German Berlin Frankfurt Munster
(BFM) regimen the intensity and duration of the chemotherapy is modified by the risk category
of the lymphoma. 5 year disease free and overall survival 90% in pediatric patients.
(Deparments of medical oncology and pathology). The overall results were of the 49 patients: 13
from the 1982-1987 period median survivor time was 190 months; 17 from the 1988-1994
median survivor time was 127 months; and 19 from the 1995- 2001 median survivor time was 48
months. In conclusion, high dose therapy as well as short intensive BFM based therapy without
consolidation produce similar results with significant but feasible toxicity in patients with
BL/BLL up to 60 years. (Deparments of medical oncology and pathology). Basically this is
saying that combining multiple treatment plans is proved very positively in the patients
outcome. There methods seemed well established and clear. I dont think I would change
anything from this study except getting more than 49 patients to participate to make the numbers
and outcomes as accurate as possible. Having additional research done on these specific types of
lymphoma would be help to get a more detailed look on how this type of cancer actually works
and behaves.
Chromosomal Abnormalities in 478 Children With Acute Myeloid Leukemia: Clinical
Characteristics and treatment Outcome in a Cooperative Pediatric Oncology Group Study the
research was done internationally but the majority of the research was done in America, France
and Great Brittan. The doctors from this trial were trying to determine if the type and frequency
of chromosomal aberration in leukemia cells of children diagnosed with acute myeloid leukemia
and enrolled in the pediatric oncology group study. (Susan C. Raimondi). The study got in touch
with its patients through a database which showed the type of cancer and the fact that the patients
has a chromosomal abnormality. They then got patients with various chromosomal abnormalities.

That was very important to the study. Between June1988 and March 1993, 666 patients younger
than 21 years with previously untreated Acute Myeloid Leukemia were registered on this study.
(Susan C. Raimondi). They then had to get parent consent from the 666 patients signed up to do
the study. One of the key factors that could rule a child out of the study was whether or not they
had a sibling willing to donate bone marrow. Then bone marrow from each child was collected
and sent to a laboratory at the University of Alabama or St. Judes research hospital. After the
bone marrow was examined and it was determined if it had the correct karyotype they could
finally get the list of children eligible for the study. The 478 patients in our study population
were assigned to 1 of 7 groups. (Susan C. Raimondi). The type of chromosomal abnormality the
patient had determined what group he/she was placed in. This study resulted in the determination
that chromosomal abnormalities fluctuate the outcome of a cancer patient. For optimal results,
future cooperative groups should compare prospectively the efficacy of individualized therapy
strategies within a defined cytogenetic subgroups of patients. (Susan C. Raimondi). If this study
were to be redone I think the best outcome would come from trying different types of
chemotherapy and radiation formulas.
Results of the randomized international FAB/LMB96 trial for intermediate risk B-cell
non-Hodgkins lymphoma in children and adolescents: it is possible to reduce treatment for early
responding patients. The research for this study was conducted in America 2006. The purpose
of this study was to determine if it was advantageous to intermediate risk B-cell non-Hodgkins
lymphoma patients to reduce treatment overtime. To be eligible for this trial the patient would
have to be a Non-immunosuppressed patient under 18 or 21 years of age with newly diagnosed
de novo mature B-cell lymphoma (either Burkitt, Burkitt-like, or DLSCL) were eligible. Other
B-cell lymphomas were not eligible. (American Society of Clinical Oncology). This study was a
planned 5 year study that opened May 1996 and closed June 2001. There were 161 patients

chosen from 3 national cancer centers but there were 600+ other patient chosen through different
methods. The primary end point of the trial was defined as the minimum amount of time
between randomization and progressive disease or relapse or a second malignancy or death
(American Society of Clinical Oncology). They started out with full doses and they used a ratio
of to determine the reduced dose of cyclophosphamide. The results of this trial were very
positive. There were only 68 failures out of 762 patients. 23 of those failures were related to no
complete remission. A following 23 of those patients were sent to regiment C and 16 of them did
not progress and were cured. (American Society of Clinical Oncology). There was 21 patients
that relapsed. This trial was the largest ever conducted in mature B-cell lymphoma of childhood
and adolescences. (American Society of Clinical Oncology). Fewer than 10% were poor
responders. The conclusion the study came to is that a 90% cure rate can be achieved with an
intensive but shortened treatment delivering low doses of cyclophosphamide and doxorubicin
thus reducing overall treatment costs. (American Society of Clinical Oncology). This study
should be a really great symbol that even the more interesting and different types of cancers can
have such a strong success rate. This is just one step closer to finding a cure. If I were to redo
something from this study I would probably get even more people to try to trial on just to hopeful
increase the number of successes. I think more research in the general lymphoma field would be
helpful to this case study. And possibly trying different types of cancers on this idea might spark
an idea that could forever change the way we look at medicine.
In Conclusion, Treatment of Burkitts/Burkitts-like lymphoma in adolescents and adults:
a 20- year experience for the Norwegian Radium Hospital with the use of three successive
regiments. Chromosomal Abnormalities in 478 Children With Acute Myeloid Leukemia:
Clinical Characteristics and treatment Outcome in a Cooperative Pediatric Oncology Group
Study, Results of the randomized international FAB/LMB96 trial for intermediate risk B-cell

non-Hodgkins lymphoma in children and adolescents: it is possible to reduce treatment for early
responding patients trials all had there ups and down but every down is a victory in a way in the
fight against cancer. Every time they lost a patient they knew they needed to change something
for the next one so they wouldnt get the same result. From these studies there will be a blossom
in someones head to think of another pediatric cancer clinical trial and every trial that gets
approved and gets started is a huge learning point for all oncologists. Finding a cure for cancer
would drastically change the medical field and the scientific field in general. The financial costs
of cancer are high for both the person with cancer and for society as a whole. The National
Institutes of Health (NIH) estimated the 2009 overall annual costs of cancer were as follows:
Total cost: $216.6 billion Direct medical costs (total of all health expenditures): $86.6 billion.
Indirect mortality costs (cost of lost productivity due to premature death): $130 billion.
(American Cancer society). The cost of cancer I only gets more expensive through the years
because the cost of treatment and medical care in general only gets more expensive. The
oncology branch of medicine is doing important things every day and making important
breakthroughs that are helping health care and people as a whole.

Reference
American Cancer society. Economic power of cancer. 2009.
American Society of Clinical Oncology. "Results of the randomized international
FAB/LMB96 trial for intermediate risk B-cell non-Hodgkins lymphoma in children and
adolescents: it is possible to reduce treatment for early responding patients."
Clinical Trials and oberservations (2006): 2773-2781. Document.
Deparments of medical oncology and pathology. "Treatment of Bukitt's/ Burkitt'slike lymphoma in adolescents and adults: a 20 year experience from the Norwegian

Radium Hospital with use of three successive regiments." European Society for
Medical oncolgy (2004): 1072-1078. Document.
Susan C. Raimondi, Myron N. Chang, Yaddanapundi Ravindranath, Frederick G.
Behm, Mary V. Gresik, C. Phillip Steuber, Howard J. Weinstein, and Andrew J. Carroll
for the pediatric oncology group. "Chromosomal Abnormalities in 478 Children WIth
Acute Myeloid Leukemia: Clinical Charateristics and Treatment Outcome in a
Cooperative Pediatric Oncology Group Study." Clinical Oberservations, Interventions,
and Therapeutic Trials (2014): 3707- 3717. Document.