OncoLog, Volume 49, Number 11, November 2004 Page: 2
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The Youngest Cancer Patients
(Continued from page 1'children (33% vs. 75% respectively),
pediatric specialists at The University
of Texas M. D. Anderson Cancer
Center point out that some types of
cancer actually have a better prognosis
in infants than in older children.
And in every case, treatment options
improve with specialized care.
"For example, children under one
year who have neuroblastoma have a
better prognosis than older children and
are therefore treated a little differently,"
said Joann Ater, M.D., a professor in the
Division of Pediatrics who has worked
at M. D. Anderson for 15 years treating
this most common form of infant
cancer. "Stage 4, or metastatic, disease
has a much more serious prognosis in a
patient who is 18 months or older than
it does in an infant. Usually, older
children get bone marrow transplants,
but the really young one; have a good
chance of being cured wth surgery and
chemotherapy. For some of them, if the
tumor is local and not metastatic, it is
curable with just surgery."
Surprisingly, though, some neuro-
blastomas are curable in infants without
any treatment at all. Over time, stage
4S neuroblastoma (a special stage,
distinct from stage 4) can actually
regress or even entirely disappear on
its own.
Genes may be key
A tumor's unique behavior in infants
may have an underlying genetic cause.
"Tumors in babies are genetically
different in many cases from tumors that
occur in older people, even in the same
types of cancer," explained Dr. Ater.
Cynthia E. Herzog, M.D., an associ-
ate professor in the Division of Pediat-
rics, explained that there is no specific
biomarker that allows researchers to
distinguish the type of reuroblastoma
that can regress on its own from others,
so it is a matter of watchful waiting and
careful balancing of treatment decisions.
"It is different, but we cannot say
exactly how it is different. It can't be
defined biologically or histologically,
and we can't predict which kids have
this type of tumor and which do not,"
said Dr. Herzog. "The trick is that you_ --
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;don't want to overtreat kids who have
tumors that will regress on their own;
on the other hand, you don't want to
undertreat the ones that don't have
the kind that will go away."
Leukemia, the second most common
cancer in infants, also behaves differ-
ently in infants than in older children.
According to Michael Rytting, M.D.,
an assistant professor in the Division of
Pediatrics and a specialist in treating
pediatric leukemia, infants with leuke-
mia generally have a worse prognosis
than older children, and the poorer
prognosis has a genetic link.
"Infants with leukemia frequently
have a rearrangement of the MLL gene
in the leukemia cell," said Dr. Rytting.
"This rearrangement is the principal
difference between babies and older
children with the disease, and it is
known to be a poor prognostic factor."
Dr. Rytting explained that accurately
diagnosing leukemia in infants can be
difficult. "Some infants with trisomy 21
have a transient myeloproliferative
disorder that looks very similar to
leukemia," he explained. "This illness
frequently resolves on its own, though
these children remain at high risk for
leukemia later in life.
"When the MLL rearrangement
is involved, it takes a little longer to
achieve remission than you might
see with older children, and resistant
disease probably is more common," said
Dr. Rytting. "These patients tend to be
negative for CD 10, the common acuteA
Emiliano and his
mother, Denise
(center), traveled
to M. D. Anderson
from Chihuahua,
Mexico, to seek
treatment for his
neuroblastoma.
Emiliano is receiving
chemotherapy, which
will be followed by
surgery to remove
the tumor.lymphocytic leukemia antigen, and those
patients are known to not do very well.
However, the small group of infants who
are positive for CD10 and do not have
the MLL rearrangement do almost as
well as other older children, so it is
important to make that distinction."
Specialized care is best
Regardless of the type of cancer,
experts agree that treatment of infants
is best handled in a highly specialized
environment. "Babies present a chal-
lenge and really should be treated in a
center that can meet their distinctive
needs," Dr. Rytting said.
For parents, having access to non-
medical support staff who specialize in
pediatric cancer can ease the strain
during a very difficult time. "For young
and sometimes inexperienced parents,
having an infant with cancer can be a
very shocking emotional experience, so
we have a lot of support staff to help,"
said Dr. Ater.
For instance, M. D. Anderson
psychologists developed a program called
"Maternal Problem Solving" to help
mothers learn to cope with catastrophic
illness. "We're very geared toward
helping young parents through problem-
atic times when their baby is diagnosed
with cancer," Dr. Ater concluded. "It just
makes things a little easier." "
FOR MORE INFORMATION, contact Dr. Ater at
(713) 792-6665, Dr. Herzog at (713) 745-
0157, or Dr. Rytting at (713) 792-4855.2
2 OncoLog " November 2004
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University of Texas M.D. Anderson Cancer Center. OncoLog, Volume 49, Number 11, November 2004, periodical, November 2004; Houston, Texas. (https://texashistory.unt.edu/ark:/67531/metapth902761/m1/2/: accessed July 17, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu.; crediting UNT Libraries Government Documents Department.