Day 3 :
- Pediatric Neuro- Oncology
Clinical Trials
Clinical Pediatrics
Session Introduction
Annick Beaugrand
Federal University, Brazil
Title: New age for pediatrics Oncology?
Time : 10:05- 10: 35
Biography:
Annick Beaugrand is a Pediatric Professor of Federal University of RN, Brazil since May, 2015 and a Pediatric oncologist at LIGA Norte-Riograndense contra o Cancer, Natal, Brazil since June, 2014, Pediatric oncologist and Clinical research at Santa Marcelina Hospital- TUCCA, São Paulo, Brazil since July 2011. He was a Pediatric oncologist and clinical and translational research at Gustave Roussy Institut, Villejuif, France from April, 2008 to June, 2011. He was a Fellow Specializing in Pediatric Hematology & Oncology at Federal University of Paraná, Brazil from January 2006 to March 2008.
Abstract:
Childhood cancer is a success story of modern medicine in which effective treatments have been identified for previously untreatable diseases. Treatment toxicity continues to be substantial despite advances in supportive care while survival rates have improved, cures for many with high risk and metastatic disease are not achievable despite aggressive surgical, chemotherapeutic and radiotherapy combination. The cure rates in pediatric oncology have been improved due to standardized treatment strategies and centralization of therapy. Much progress has been made using chemotherapeutic agents and treatment modalities introduced decades ago with refinement to improve disease-free survival. Better understanding of treatment-related toxicity has guided the design of less-toxic therapies. Elucidation of the principles of tumor biology and the development of novel laboratory technologies have led to significant progress, as bringing immunotherapies to the bedside. Understanding the molecular basis is changing the landscape of molecular genetics and genomic testing that may be used to identify risk factors, although the clinical utility of such testing is unclear. Molecular sub-typing is instrumental towards selection of model systems for fundamental research in tumor pathogenesis (as new medulloblastoma disease classification) and clinical patient assessment and can also be used to identify variants that influence drug metabolism or interaction of a drug with its cellular target, allowing customization of choice of drug and dosage. There has been significant progress in the clinical development of monoclonal antibodies as cancer therapies with promising results emerging from pediatric studies. Dramatic progress in scientific discovery and technology has led to rapid development and translation of therapies for the clinic. The challenge to the field of pediatric oncology is to develop biologic based approaches that enhance the benefits of standard therapies, lessen toxicity and extend the gains in survival to those high-risk groups that have not benefited from standard treatment.
Janak Kishore
Sanjay Gandhi Post-Graduate Institute of Medical Sciences, India
Title: Expanding spectrum of Parvovirus B19 in Paediatric Infections: what’s more than Fifth’s Disease
Time : 10:35-11:05
Biography:
Dr. Janak Kishore graduated in medicine did M.D. (Microbiology) in 1985. Currently he is Professor & Chief of Serology, Clinical & Molecular Virology, Department of Microbiology. He was Associate Editor of Indian J Virol, elected member National Academy Medical Sciences, member of American Societies, and got JICA fellowship, Japan. Dr Kishore taught for 34 yrs, published 51 papers. Dr Kishore did pioneer work on human parvovirus B19 with three novel clinical associations besides reporting “Oncolytic” property of B19 which fetched awards. He was reviewer for international journals, chaired sessions, invited speaker at international conferences (USA, Canada, Japan, U.K. China)
Abstract:
Fifth disease or Erythema infectiosum (EI) in children was known prior to its discovery of B19 in 1974 (reviewed in Kishore J, Kapoor A; 2000) but only after 7 yrs later disease causation by B19 were first recognized as TAC (1981) then arthropathy (1983) & non-immune hydrops fetalis (1987). Since then clinical spectrum of B19 infections were found increasingly hence we developed diagnostic tools for B19 (ELISA, PCR) and determined its seroprevalence (39.9%) in 1000 blood-donors (Kishore J et al; 2005, 2010). We reported novel, unique cases of pure acquired amegakaryocytic thrombocytopenia in a 9 mo male (Kishore J et al; 2005) and another case of myositis in 9 yr female as a complication of EI (Kishore J et al; 2006) supported later by other investigators. Again cases of thrombocytopenia and anaemia in a child with fulminant hepatitis due to B19 infection (Kishore J et al; 2009) and a fatal case of hemophagocytic lymphohistiocytosis induced by B19 and EBV in a 2 mo male infant were reported (Kishore J et al; 2014). Major studies included juvenile rheumatoid arthropathy (fulfilling ARA criteria) in 82 children and B19 infection was found in 27 % (Kishore J et al; 1998). Foetal wastage in recurrent aborters and in high risk pregnant women (n=60) revealed high proportions with B19 infection (Kishore J et al; 2011, 2006). Multi-transfused beta-thalassemia major (n=92) children (mean age 8 yrs) had high frequency of anti-B19 IgM (41.1%) antibodies (Kishore Jet al; 2011). In 29 paediatric leukaemia (mostly ALL) we reported (Kishore J et al; 2011) prolonged induction therapy, persistent anaemia while mortality was 17% in B19 infected group but nil in un-infected group indicating B19 may be naturally Oncolytic (Kishore J; 2014) further prolonged remission in a child with CLL and another with CML (co-author Kishore J; 2015) ratified our clinical observations. Now several reports on paediatric B19 infections have cumulated to signify big role of B19 virus but unfortunately B19 infections are largely ignored.
Abdulqader Al-Hebshi
Prince Mohammed Bin Abdul Aziz Hospital, Saudi Arabia
Title: Syndromatic osteosarcoma, does it carry a poor prognosis? King Hussein Cancer centre experience
Time : 11:25-11:55
Biography:
Abdulqader Al-Hebshi has completed his Jordanian and Arab Board in general Pediatrics in 2010 then he did a Clinical Fellowship in Pediatric Hematology Oncology for three years from King Hussein Cancer Centre in Jordan after that he joined The Hospital For Sick Children in Toronto to do one Year Clinical Fellowship 2014-2015, Currently he is a consultant of Hematology & Oncology and the clinical supervisor of medical interns at Prince Mohammed Bin Abdul Aziz Hospital- National Guard Hospital Affair in Saudia Arabia. He is an active member in ASPHO American Society of Hematology & Oncology.
Abstract:
Association of osteosarcoma with certain syndromes is well known, but the incidence varies from one report to another, and from one syndrome to another, Ruthmond syndrome is the most common syndrome reported to be associated while others like Blackfan Diamond anemia and Osteogenesis imperfect are very rarely associated, and others like Osteopoikelosis are never reported to be associated with Osteosarcoma. Retrospectively we reviewed files of all patients diagnosed to have osteosarcoma during the period from January 2003 till December 2011, information regarding presence of syndromatic features, current condition of the patient whether alive or death or lost and whether had localized or metastatic disease at diagnosis were recorded.
Nahla Mobark
King Fahad Medical City, Saudi Arabia
Title: Pediatric Non-Hodgkin Lymphoma: A Retrospective 7-Year Experience in Children& Adolescents with Non-Hodgkin Lymphoma Treated in King Fahad Medical City (KFMC)
Biography:
Dr Nahla Mobark is pediatric oncologist in Pediatric Hematology & Oncology Department in Cancer Center King Fahad Medical City KFMC, Riyadh Saudi Arabia which is huge tertiary hospital in with around 1000 bed capacity. She had MBBS from KASER-ELAINI Medical College Cairo University, then pediatric residency in Children hospital king Saud medical complex KSMC Ministry of Health (MOH) of Saudi Arabia ,she had membership of Royal College Of Pediatric & Child Health, UK MRCPCH, and then pediatric hematology oncology fellowship program with training in bone marrow transplant. She had got a big experience in diagnosing &management of pediatric patients with hematological malignancies and solid tumours also benign hematology cases i.e .SCA, thalassemia etc. Dr Nahla have been involved with teaching of undergraduate and postgraduate students and nurses throughout her career.
Abstract:
Non-Hodgkin’s lymphoma is an aggressive malignant disease in children and adolescents. Although it is the fourth most common malignancy in Saudi children as reported in Saudi cancer registry, less information is available about pediatric Non-Hodgkin lymphoma and its outcome in Saudi Arabia. Study Objectives: To provide demographic data, disease characteristics, treatment protocol, toxicity and outcome of treatment in children & adolescents with Non-Hodgkin’s lymphoma treated at KFMC. This study will form base line for future studies about pediatric Non-Hodgkin’s lymphoma in KFMC, which may help to improve outcome for children with cancer in Saudi Arabia. Study Patients and Method: We retrospectively analyzed 28 children and adolescents diagnosed to have Non-Hodgkin’s lymphoma at KFMC between December 2006 and December 2013, followed-up through June 2014. Results: Of the 28 patients, 10 (35.7%) girls and 18 (64.3%) boys, the male-to-female ratio was 1.8; 1. The median age at time of diagnosis was 6.4 years old (range 2.0 to 13.0 years old). The majority of patients (64.3%) were aged between 5 and 12 years old. Burkitt’s lymphoma BL/BLL was the most common pathological subtype (60.7%), and DLBCL was the second most common subtype (21.4%). Abdominal and Retroperitoneal involvement was the most common primary site (78.6%) including the ileocaecal region. Most of the children presented with advanced Stage III and IV (75%), Cytogenetic study which screens specifically for the t (8; 14) (q24; q32) a characteristic genetic feature of Burkitt’s Lymphoma was obtained from 21 patients, variant rearrangement was observed in 3/21 samples and complex chromosomes karyotype in addition to IGH/MYC rearrangement was observed in 2/21 samples
Imke Bartelink
University of California, USA
Title: Individualized treatment with an optimal risk-benefit in children using pharmacokinetic-pharmacodynamic modeling in pediatric diseases and solid tumors
Time : 12:25-12:45
Biography:
Imke H. Bartelink completed her PharmD and PhD in clinical pharmacology in pediatric hematopoietic cell transplantation from the Utrecht Medical Center in Utrecht, The Netherlands and postdoctoral studies in integrative pharmacology from the University of California, San Francisco (UCSF). Currently, Dr. Bartelink is in the Clinical Pharmacology Fellowship at UCSF at the Early Phase Clinical Trials Unit. She published more than 20 papers in high impact peer reviewed journals in the areas of pediatric dosing guidelines, pediatric pharmacokinetic-outcome associations and biomarkers of response.
Abstract:
The dose of drugs in pediatrics is routinely calculated in an empirical manner using information from adult-studies with either body surface area (BSA), bodyweight based dosing or allometric scaling, even though most developmental changes in the pharmacokinetics (PK) and pharmacodynamics (PD) are non-linear dynamic processes. The design of dosing regimens for the treatment of solid tumors in children is further complicated by the interplay between the tumor and the tumor environment. Historically, understanding such concentration-outcome relationships in children has been a challenge, due to limitations on blood volumes, invasive tumor biopsies, ethical considerations, bioanalytical sensitivity and PK modeling methodologies. However, our studies with busulfan, carboplatin and veliparib are an example that these barriers can be overcome.
Herman Suit
Massachusetts General Hospital, USA
Title: Evidence for Existence of a Small Population of Radiation Resistant Stem Cells.
Biography:
Herman Suit was born on February 8, 1929 in Houston Texas and educated in the Houston public schools and the University of Houston obtaining a B. Sc in August 1948. He graduated from Baylor Medical School [AOA] in 1952, MD and M.Sc [biochemistry]. In 1970, Suit was brought to MGH as Chief of Radiation Oncology and a Professor at Harvard Medical School. After 30 years, Suit was exceedingly pleased to transfer the Chief’s position to Jay S Loeffler on October 1, 2000 and to observe his clear success.
Abstract:
There are many data that support the concept of drug resistant stem cell populations. Stem cells as a sub-population of radiation resistant tumor cells are almost generally accepted as a component of human tumors. This has conceptually been extended to the concept that the stem cell population is radiation resistant and is the basis for local regrowth of tumors treated by radiation with intent to cure. There have been no quantitation of: 1] the fraction of tumor cells that are members of this stem cell population; 2] radiation sensitivity of these resistant cells relative to the other tumor cells and 3] micro enviornment of these stem cells. There has not been generated experimental data that supports the concept of a small radiation resistant population of stem cells. In fact, the published data encountered have yielded the opposite of. For example, two experiments, performed in laboratories in different countries, have reported that the TCD50 values [dose to inactivate half of the irradiated tumors] were significantly less for transplants of the recurrent tumors than for the previously unirradiated tumors. Further radiation cell survival curves for numerous mammalian cell lines studied in vitro by measuring survival fraction vs dose for survival fraction of 10-[2-4] provided no evidence of a resistant sub-population. One current paper, found that decreasing the number of endothelial cells in tumors did not alter tumor response. These findings and others will be considered.
Biography:
Xudong Miao has completed his PhD at the age of 31 years from Zhejiang University School of Medicine. He is the director of the Department of Orthopedic Oncologen & Ankle Surgery, the Second Affiliated Hospital, Zhejiang University. He has published 20 papers in peer reviewed journals and has been serving as an princepal invesitigator of 3 .Orthopedic Oncologen Research Project
Abstract:
Our previous studies suggest that nanosecond pulsed electric field (nsPEF) is a novel minimal invasive and non-thermal ablation method that can induce apoptosis in.osteosarcoma MG-63 cells in vitro. The current study investigates the local and systemic antitumor efficacy of nsPEF on osteosarcoma in vivo with micro metastasis. Osteosarcomas were treated by nsPEF with puncture electrode at 40 Kv/cm electric field strength of 500 pulses. The survival time, tumor volume, serum alkaline phosphatase, joint capsule and lung metastasis were followed up to 6 months post nsPEF treatment. The efficacy was compared with no-treatment control and amputation surgery. nsPEF reduced tumor volume compared to the control group (P<0.05), it also inhibit serum alkaline phosphatase and lung metastasis, prolonged the survival time without joint deformity or capsule rupture. nsPEF cannot eradicate the tumor as amputation surgery (P<0.05), but the complication and hospitalization time were lower. Local nsPEF ablation was found to be effective in achieving longer survival and less lung metastasis without chemotherapy, radiotherapy or biological therapy. As a non-thermal ablation method, nsPEF has potential to treat osteosarcoma as a palliative therapy for osteosarcoma patients who constricted for surgery.
Soad Jaouni
King Abdulaziz University, Saudi Arabia
Title: Novel Methodology of Detecting Minimal Residual Disease in Acute Leukemia by Using FTIR Spectroscopy
Biography:
Dr. Soad K. Al Jaouni is a Professor & Consultant of Hematology and Professor/Consultant of Pediatric Hematology/Oncology, Senior Researcher at Hematology Department, Faculty of Medicine, King Abdulaziz University Hospital (KAUH) a tertiary care medical center, King Abdulaziz University (KAU), Jeddah, Kingdom of Saudi Arabia.
Abstract:
Previously examined the potential of conventional Fourier transform infrared spectroscopy (FTIR) in an attempt to detect specific biomarkers for discrimination between disease free and acute leukemia bone marrow samples.
AIM: To assess the efficacy in detecting minimal residual disease in acute leukemia by FTIR.
Case report, to predict early relapse, and distinguish disease free in remission (control) bone marrow samples, four bone marrow samples were obtained from an 11-year-old boy diagnosed as acute leukemia. Samples (1) and (2) for the patient in remission as diagnosed clinically and laboratory examination free, sample (3) diagnosed relapse in CNS, while sample (4) was taken post-chemotherapy induction.
Biography:
Dr.Divya SubburajCurrently doing FNB( Fellowship under the national board) in pediatric hematology and oncology at Apollo hospital,Chennai from feb 2015. She Completed her undergraduation in 2009 from Bangalore medical college and research institute. She have done my specialisation in Pediatrics(M D ) from the above Institute. She Completed MRCPCH part 1 & 2.
Abstract:
A total of fifty four children had received induction chemotherapy consisting of duanorubicin, cytarabine and etoposide as per the UKMRC AML induction protocol were included in the study. Forty seven episodes of febrile neutropenia were recorded. Thirty four percent had culture positive gram negative sepsis. Fifty five percent of the febrile neutropenic episodes were blood culture negative. Enterocolitis was the most common focus of infection in these children.
Over the last 3 years (2012-2015) the incidence of gram negative sepsis had risen to 38% when compared to 24% during the 2003 to 2011 period. Though the mortality rates had remained the same in both groups, the morbidity rates which included duration of hospital stay, need for pediatric intensive care support, the use of colistin due to carbapenam resistant infections and the use of granulocyte transfusions to help tide over the sepsis had dramatically increased.