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Shaikh F, Cullen JW, Olson TA, Pashankar F, Malogolowkin MH, Amatruda JF, Villaluna D, Krailo M, Billmire DF, Rescorla FJ, Egler RA, Dicken BJ, Ross JH, Schlatter M, Rodriguez-Galindo C, Frazier AL. Reduced and Compressed Cisplatin-Based Chemotherapy in Children and Adolescents With Intermediate-Risk Extracranial Malignant Germ Cell Tumors: A Report From the Children's Oncology Group. J Clin Oncol 2017; 35:1203-1210. [PMID: 28240974 DOI: 10.1200/jco.2016.67.6544] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Purpose To investigate whether event-free survival (EFS) can be maintained among children and adolescents with intermediate-risk (IR) malignant germ cell tumors (MGCT) if the administration of cisplatin, etoposide, and bleomycin (PEb) is reduced from four to three cycles and compressed from 5 to 3 days per cycle. Patients and Methods In a phase 3, single-arm trial, patients with IR MGCT (stage II-IV testicular, II-III ovarian, I-II extragonadal, or stage I gonadal tumors with subsequent recurrence) received three cycles of PEb. A parametric comparator model specified that the observed EFS rate should not be significantly < 92%. As recommended for trials that test a reduction of therapy, a one-sided P value ≤ .10 was used to indicate statistical significance. In a post hoc analysis, we also compared results to the EFS rate of comparable patients treated with four cycles of PEb in two prior studies. Results Among 210 eligible patients enrolled from 2003 to 2011, 4-year EFS (EFS4) rate was 89% (95% confidence interval, 83% to 92%), which was significantly lower than the 92% threshold of the comparison model ( P = .08). Among 181 newly diagnosed patients, the EFS4 rate was 87%, compared with 92% for 92 comparable children in the historical cohort ( P = .15). The EFS4 rate was significantly associated with stage (stage I, 100%; stage II, 92%; stage III, 85%; and stage IV, 54%; P < .001). Conclusion The EFS rate for children with IR MGCT observed after three cycles of PEb was less than that of a prespecified parametric model, particularly for patients with higher-stage tumors. These data do not support a reduction in the number of cycles of PEb from four to three. However, further investigation of a reduction in the number of cycles for patients with lower-stage tumors is warranted.
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Affiliation(s)
- Furqan Shaikh
- Furqan Shaikh, The Hospital for Sick Children, University of Toronto, Toronto, Canada; John W. Cullen, Rocky Mountain Hospital for Children-Presbyterian Saint Luke's Medical Center, Denver, CO; Thomas A. Olson, Children's Healthcare of Atlanta, and Emory University, Atlanta, GA; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Marcio H. Malogolowkin, University of California Davis Comprehensive Cancer Center, Sacramento; Doojduen Villaluna and Mark Krailo, Children's Oncology Group, Monrovia; Mark Krailo, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center Dallas, Dallas, TX; Deborah F. Billmire and Frederick J. Rescorla, Riley Hospital for Children, Indianapolis, IN; Rachel A. Egler and Jonathan H. Ross, Rainbow Babies and Children's Hospital, Cleveland, OH; Bryan J. Dicken, Stollery Children's Hospital, and University of Alberta Hospital, Edmonton, Alberta, Canada; Marc Schlatter, Helen DeVos Children's Hospital at Spectrum Health, Grand Rapids, MI; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and A. Lindsay Frazier, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA
| | - John W Cullen
- Furqan Shaikh, The Hospital for Sick Children, University of Toronto, Toronto, Canada; John W. Cullen, Rocky Mountain Hospital for Children-Presbyterian Saint Luke's Medical Center, Denver, CO; Thomas A. Olson, Children's Healthcare of Atlanta, and Emory University, Atlanta, GA; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Marcio H. Malogolowkin, University of California Davis Comprehensive Cancer Center, Sacramento; Doojduen Villaluna and Mark Krailo, Children's Oncology Group, Monrovia; Mark Krailo, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center Dallas, Dallas, TX; Deborah F. Billmire and Frederick J. Rescorla, Riley Hospital for Children, Indianapolis, IN; Rachel A. Egler and Jonathan H. Ross, Rainbow Babies and Children's Hospital, Cleveland, OH; Bryan J. Dicken, Stollery Children's Hospital, and University of Alberta Hospital, Edmonton, Alberta, Canada; Marc Schlatter, Helen DeVos Children's Hospital at Spectrum Health, Grand Rapids, MI; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and A. Lindsay Frazier, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA
| | - Thomas A Olson
- Furqan Shaikh, The Hospital for Sick Children, University of Toronto, Toronto, Canada; John W. Cullen, Rocky Mountain Hospital for Children-Presbyterian Saint Luke's Medical Center, Denver, CO; Thomas A. Olson, Children's Healthcare of Atlanta, and Emory University, Atlanta, GA; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Marcio H. Malogolowkin, University of California Davis Comprehensive Cancer Center, Sacramento; Doojduen Villaluna and Mark Krailo, Children's Oncology Group, Monrovia; Mark Krailo, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center Dallas, Dallas, TX; Deborah F. Billmire and Frederick J. Rescorla, Riley Hospital for Children, Indianapolis, IN; Rachel A. Egler and Jonathan H. Ross, Rainbow Babies and Children's Hospital, Cleveland, OH; Bryan J. Dicken, Stollery Children's Hospital, and University of Alberta Hospital, Edmonton, Alberta, Canada; Marc Schlatter, Helen DeVos Children's Hospital at Spectrum Health, Grand Rapids, MI; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and A. Lindsay Frazier, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA
| | - Farzana Pashankar
- Furqan Shaikh, The Hospital for Sick Children, University of Toronto, Toronto, Canada; John W. Cullen, Rocky Mountain Hospital for Children-Presbyterian Saint Luke's Medical Center, Denver, CO; Thomas A. Olson, Children's Healthcare of Atlanta, and Emory University, Atlanta, GA; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Marcio H. Malogolowkin, University of California Davis Comprehensive Cancer Center, Sacramento; Doojduen Villaluna and Mark Krailo, Children's Oncology Group, Monrovia; Mark Krailo, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center Dallas, Dallas, TX; Deborah F. Billmire and Frederick J. Rescorla, Riley Hospital for Children, Indianapolis, IN; Rachel A. Egler and Jonathan H. Ross, Rainbow Babies and Children's Hospital, Cleveland, OH; Bryan J. Dicken, Stollery Children's Hospital, and University of Alberta Hospital, Edmonton, Alberta, Canada; Marc Schlatter, Helen DeVos Children's Hospital at Spectrum Health, Grand Rapids, MI; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and A. Lindsay Frazier, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA
| | - Marcio H Malogolowkin
- Furqan Shaikh, The Hospital for Sick Children, University of Toronto, Toronto, Canada; John W. Cullen, Rocky Mountain Hospital for Children-Presbyterian Saint Luke's Medical Center, Denver, CO; Thomas A. Olson, Children's Healthcare of Atlanta, and Emory University, Atlanta, GA; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Marcio H. Malogolowkin, University of California Davis Comprehensive Cancer Center, Sacramento; Doojduen Villaluna and Mark Krailo, Children's Oncology Group, Monrovia; Mark Krailo, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center Dallas, Dallas, TX; Deborah F. Billmire and Frederick J. Rescorla, Riley Hospital for Children, Indianapolis, IN; Rachel A. Egler and Jonathan H. Ross, Rainbow Babies and Children's Hospital, Cleveland, OH; Bryan J. Dicken, Stollery Children's Hospital, and University of Alberta Hospital, Edmonton, Alberta, Canada; Marc Schlatter, Helen DeVos Children's Hospital at Spectrum Health, Grand Rapids, MI; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and A. Lindsay Frazier, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA
| | - James F Amatruda
- Furqan Shaikh, The Hospital for Sick Children, University of Toronto, Toronto, Canada; John W. Cullen, Rocky Mountain Hospital for Children-Presbyterian Saint Luke's Medical Center, Denver, CO; Thomas A. Olson, Children's Healthcare of Atlanta, and Emory University, Atlanta, GA; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Marcio H. Malogolowkin, University of California Davis Comprehensive Cancer Center, Sacramento; Doojduen Villaluna and Mark Krailo, Children's Oncology Group, Monrovia; Mark Krailo, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center Dallas, Dallas, TX; Deborah F. Billmire and Frederick J. Rescorla, Riley Hospital for Children, Indianapolis, IN; Rachel A. Egler and Jonathan H. Ross, Rainbow Babies and Children's Hospital, Cleveland, OH; Bryan J. Dicken, Stollery Children's Hospital, and University of Alberta Hospital, Edmonton, Alberta, Canada; Marc Schlatter, Helen DeVos Children's Hospital at Spectrum Health, Grand Rapids, MI; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and A. Lindsay Frazier, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA
| | - Doojduen Villaluna
- Furqan Shaikh, The Hospital for Sick Children, University of Toronto, Toronto, Canada; John W. Cullen, Rocky Mountain Hospital for Children-Presbyterian Saint Luke's Medical Center, Denver, CO; Thomas A. Olson, Children's Healthcare of Atlanta, and Emory University, Atlanta, GA; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Marcio H. Malogolowkin, University of California Davis Comprehensive Cancer Center, Sacramento; Doojduen Villaluna and Mark Krailo, Children's Oncology Group, Monrovia; Mark Krailo, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center Dallas, Dallas, TX; Deborah F. Billmire and Frederick J. Rescorla, Riley Hospital for Children, Indianapolis, IN; Rachel A. Egler and Jonathan H. Ross, Rainbow Babies and Children's Hospital, Cleveland, OH; Bryan J. Dicken, Stollery Children's Hospital, and University of Alberta Hospital, Edmonton, Alberta, Canada; Marc Schlatter, Helen DeVos Children's Hospital at Spectrum Health, Grand Rapids, MI; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and A. Lindsay Frazier, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA
| | - Mark Krailo
- Furqan Shaikh, The Hospital for Sick Children, University of Toronto, Toronto, Canada; John W. Cullen, Rocky Mountain Hospital for Children-Presbyterian Saint Luke's Medical Center, Denver, CO; Thomas A. Olson, Children's Healthcare of Atlanta, and Emory University, Atlanta, GA; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Marcio H. Malogolowkin, University of California Davis Comprehensive Cancer Center, Sacramento; Doojduen Villaluna and Mark Krailo, Children's Oncology Group, Monrovia; Mark Krailo, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center Dallas, Dallas, TX; Deborah F. Billmire and Frederick J. Rescorla, Riley Hospital for Children, Indianapolis, IN; Rachel A. Egler and Jonathan H. Ross, Rainbow Babies and Children's Hospital, Cleveland, OH; Bryan J. Dicken, Stollery Children's Hospital, and University of Alberta Hospital, Edmonton, Alberta, Canada; Marc Schlatter, Helen DeVos Children's Hospital at Spectrum Health, Grand Rapids, MI; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and A. Lindsay Frazier, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA
| | - Deborah F Billmire
- Furqan Shaikh, The Hospital for Sick Children, University of Toronto, Toronto, Canada; John W. Cullen, Rocky Mountain Hospital for Children-Presbyterian Saint Luke's Medical Center, Denver, CO; Thomas A. Olson, Children's Healthcare of Atlanta, and Emory University, Atlanta, GA; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Marcio H. Malogolowkin, University of California Davis Comprehensive Cancer Center, Sacramento; Doojduen Villaluna and Mark Krailo, Children's Oncology Group, Monrovia; Mark Krailo, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center Dallas, Dallas, TX; Deborah F. Billmire and Frederick J. Rescorla, Riley Hospital for Children, Indianapolis, IN; Rachel A. Egler and Jonathan H. Ross, Rainbow Babies and Children's Hospital, Cleveland, OH; Bryan J. Dicken, Stollery Children's Hospital, and University of Alberta Hospital, Edmonton, Alberta, Canada; Marc Schlatter, Helen DeVos Children's Hospital at Spectrum Health, Grand Rapids, MI; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and A. Lindsay Frazier, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA
| | - Frederick J Rescorla
- Furqan Shaikh, The Hospital for Sick Children, University of Toronto, Toronto, Canada; John W. Cullen, Rocky Mountain Hospital for Children-Presbyterian Saint Luke's Medical Center, Denver, CO; Thomas A. Olson, Children's Healthcare of Atlanta, and Emory University, Atlanta, GA; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Marcio H. Malogolowkin, University of California Davis Comprehensive Cancer Center, Sacramento; Doojduen Villaluna and Mark Krailo, Children's Oncology Group, Monrovia; Mark Krailo, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center Dallas, Dallas, TX; Deborah F. Billmire and Frederick J. Rescorla, Riley Hospital for Children, Indianapolis, IN; Rachel A. Egler and Jonathan H. Ross, Rainbow Babies and Children's Hospital, Cleveland, OH; Bryan J. Dicken, Stollery Children's Hospital, and University of Alberta Hospital, Edmonton, Alberta, Canada; Marc Schlatter, Helen DeVos Children's Hospital at Spectrum Health, Grand Rapids, MI; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and A. Lindsay Frazier, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA
| | - Rachel A Egler
- Furqan Shaikh, The Hospital for Sick Children, University of Toronto, Toronto, Canada; John W. Cullen, Rocky Mountain Hospital for Children-Presbyterian Saint Luke's Medical Center, Denver, CO; Thomas A. Olson, Children's Healthcare of Atlanta, and Emory University, Atlanta, GA; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Marcio H. Malogolowkin, University of California Davis Comprehensive Cancer Center, Sacramento; Doojduen Villaluna and Mark Krailo, Children's Oncology Group, Monrovia; Mark Krailo, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center Dallas, Dallas, TX; Deborah F. Billmire and Frederick J. Rescorla, Riley Hospital for Children, Indianapolis, IN; Rachel A. Egler and Jonathan H. Ross, Rainbow Babies and Children's Hospital, Cleveland, OH; Bryan J. Dicken, Stollery Children's Hospital, and University of Alberta Hospital, Edmonton, Alberta, Canada; Marc Schlatter, Helen DeVos Children's Hospital at Spectrum Health, Grand Rapids, MI; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and A. Lindsay Frazier, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA
| | - Bryan J Dicken
- Furqan Shaikh, The Hospital for Sick Children, University of Toronto, Toronto, Canada; John W. Cullen, Rocky Mountain Hospital for Children-Presbyterian Saint Luke's Medical Center, Denver, CO; Thomas A. Olson, Children's Healthcare of Atlanta, and Emory University, Atlanta, GA; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Marcio H. Malogolowkin, University of California Davis Comprehensive Cancer Center, Sacramento; Doojduen Villaluna and Mark Krailo, Children's Oncology Group, Monrovia; Mark Krailo, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center Dallas, Dallas, TX; Deborah F. Billmire and Frederick J. Rescorla, Riley Hospital for Children, Indianapolis, IN; Rachel A. Egler and Jonathan H. Ross, Rainbow Babies and Children's Hospital, Cleveland, OH; Bryan J. Dicken, Stollery Children's Hospital, and University of Alberta Hospital, Edmonton, Alberta, Canada; Marc Schlatter, Helen DeVos Children's Hospital at Spectrum Health, Grand Rapids, MI; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and A. Lindsay Frazier, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA
| | - Jonathan H Ross
- Furqan Shaikh, The Hospital for Sick Children, University of Toronto, Toronto, Canada; John W. Cullen, Rocky Mountain Hospital for Children-Presbyterian Saint Luke's Medical Center, Denver, CO; Thomas A. Olson, Children's Healthcare of Atlanta, and Emory University, Atlanta, GA; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Marcio H. Malogolowkin, University of California Davis Comprehensive Cancer Center, Sacramento; Doojduen Villaluna and Mark Krailo, Children's Oncology Group, Monrovia; Mark Krailo, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center Dallas, Dallas, TX; Deborah F. Billmire and Frederick J. Rescorla, Riley Hospital for Children, Indianapolis, IN; Rachel A. Egler and Jonathan H. Ross, Rainbow Babies and Children's Hospital, Cleveland, OH; Bryan J. Dicken, Stollery Children's Hospital, and University of Alberta Hospital, Edmonton, Alberta, Canada; Marc Schlatter, Helen DeVos Children's Hospital at Spectrum Health, Grand Rapids, MI; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and A. Lindsay Frazier, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA
| | - Marc Schlatter
- Furqan Shaikh, The Hospital for Sick Children, University of Toronto, Toronto, Canada; John W. Cullen, Rocky Mountain Hospital for Children-Presbyterian Saint Luke's Medical Center, Denver, CO; Thomas A. Olson, Children's Healthcare of Atlanta, and Emory University, Atlanta, GA; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Marcio H. Malogolowkin, University of California Davis Comprehensive Cancer Center, Sacramento; Doojduen Villaluna and Mark Krailo, Children's Oncology Group, Monrovia; Mark Krailo, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center Dallas, Dallas, TX; Deborah F. Billmire and Frederick J. Rescorla, Riley Hospital for Children, Indianapolis, IN; Rachel A. Egler and Jonathan H. Ross, Rainbow Babies and Children's Hospital, Cleveland, OH; Bryan J. Dicken, Stollery Children's Hospital, and University of Alberta Hospital, Edmonton, Alberta, Canada; Marc Schlatter, Helen DeVos Children's Hospital at Spectrum Health, Grand Rapids, MI; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and A. Lindsay Frazier, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA
| | - Carlos Rodriguez-Galindo
- Furqan Shaikh, The Hospital for Sick Children, University of Toronto, Toronto, Canada; John W. Cullen, Rocky Mountain Hospital for Children-Presbyterian Saint Luke's Medical Center, Denver, CO; Thomas A. Olson, Children's Healthcare of Atlanta, and Emory University, Atlanta, GA; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Marcio H. Malogolowkin, University of California Davis Comprehensive Cancer Center, Sacramento; Doojduen Villaluna and Mark Krailo, Children's Oncology Group, Monrovia; Mark Krailo, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center Dallas, Dallas, TX; Deborah F. Billmire and Frederick J. Rescorla, Riley Hospital for Children, Indianapolis, IN; Rachel A. Egler and Jonathan H. Ross, Rainbow Babies and Children's Hospital, Cleveland, OH; Bryan J. Dicken, Stollery Children's Hospital, and University of Alberta Hospital, Edmonton, Alberta, Canada; Marc Schlatter, Helen DeVos Children's Hospital at Spectrum Health, Grand Rapids, MI; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and A. Lindsay Frazier, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA
| | - A Lindsay Frazier
- Furqan Shaikh, The Hospital for Sick Children, University of Toronto, Toronto, Canada; John W. Cullen, Rocky Mountain Hospital for Children-Presbyterian Saint Luke's Medical Center, Denver, CO; Thomas A. Olson, Children's Healthcare of Atlanta, and Emory University, Atlanta, GA; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Marcio H. Malogolowkin, University of California Davis Comprehensive Cancer Center, Sacramento; Doojduen Villaluna and Mark Krailo, Children's Oncology Group, Monrovia; Mark Krailo, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center Dallas, Dallas, TX; Deborah F. Billmire and Frederick J. Rescorla, Riley Hospital for Children, Indianapolis, IN; Rachel A. Egler and Jonathan H. Ross, Rainbow Babies and Children's Hospital, Cleveland, OH; Bryan J. Dicken, Stollery Children's Hospital, and University of Alberta Hospital, Edmonton, Alberta, Canada; Marc Schlatter, Helen DeVos Children's Hospital at Spectrum Health, Grand Rapids, MI; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and A. Lindsay Frazier, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA
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Olson TA, Murray MJ, Rodriguez-Galindo C, Nicholson JC, Billmire DF, Krailo MD, Dang HM, Amatruda JF, Thornton CM, Arul GS, Stoneham SJ, Pashankar F, Stark D, Shaikh F, Gershenson DM, Covens A, Hurteau J, Stenning SP, Feldman DR, Grimison PS, Huddart RA, Sweeney C, Powles T, Lopes LF, dos Santos Agular S, Chinnaswamy G, Khaleel S, Abouelnaga S, Hale JP, Frazier AL. Pediatric and Adolescent Extracranial Germ Cell Tumors: The Road to Collaboration. J Clin Oncol 2015; 33:3018-28. [PMID: 26304902 PMCID: PMC4979195 DOI: 10.1200/jco.2014.60.5337] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
During the past 35 years, survival rates for children with extracranial malignant germ cell tumors (GCTs) have increased significantly. Success has been achieved primarily through the application of platinum-based chemotherapy regimens; however, clinical challenges in GCTs remain. Excellent outcomes are not distributed uniformly across the heterogeneous distribution of age, histologic features, and primary tumor site. Despite good outcomes overall, the likelihood of a cure for certain sites and histologic conditions is less than 50%. In addition, there are considerable long-term treatment-related effects for survivors. Even modest cisplatin dosing can cause significant long-term morbidities. A particular challenge in designing new therapies for GCT is that a variety of specialists use different risk stratifications, staging systems, and treatment approaches for three distinct age groups (childhood, adolescence, and young adulthood). Traditionally, pediatric cancer patients younger than 15 years have been treated by pediatric oncologists in collaboration with their surgical specialty colleagues. Adolescents and young adults with GCTs often are treated by medical oncologists, urologists, or gynecologic oncologists. The therapeutic dilemma for all is how to best define disease risk so that therapy and toxicity can be appropriately reduced for some patients and intensified for others. Further clinical and biologic insights can only be achieved through collaborations that do not set limitations by age, sex, and primary tumor site. Therefore, international collaborations, spanning different cooperative groups and disciplines, have been developed to address these challenges.
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Affiliation(s)
- Thomas A. Olson
- Thomas A. Olson, Emory University, Atlanta, GA; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom; Carlos Rodriguez-Galindo and A. Lindsay Frazier, Boston Children's Hospital, Boston; Carlos Rodriguez-Galindo, A. Lindsay Frazier, and Christopher Sweeney, Dana-Farber Cancer Institute, Boston, MA; Deborah F. Billmore, Riley Hospital for Sick Children, Indianapolis, IN; Mark D. Krailo and Ha M. Dang, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas; David M. Gershenson, University of Texas MD Anderson Cancer Center, Houston, TX; Claire M. Thornton, Royal Victoria Hospital, Belfast, United Kingdom; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom; Sara J. Stoneham, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Daniel Stark, University of Leeds, Leeds, United Kingdom; Furqan Shaikh, The Hospital for Sick Children, Toronto; Allan Covens, University of Toronto, Toronto, Ontario, Canada; Jean Hurteau, University of Chicago Pritzker School of Medicine, Chicago, IL; Sally P. Stenning, Medical Research Council, London, United Kingdom; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Peter S. Grimison, Sydney Cancer Center, Sydney, New South Wales, Australia; Robert A. Huddart, Institute of Cancer Research and Royal Marsden Hospital, Surrey, United Kingdom; Thomas Powles, Barts Cancer Institute, London, United Kingdom; Luiz Fernando Lopes, Barretos Pediatric Cancer Center, São Paulo, Brazil; Simone dos Santos Agular, Centro Infantil Boldrini, Campinas, Brazil; Girish Chinnaswamy, Tata Memorial Hospital, Mumbai, India; Sahar Khaleel and Sherif Abouelnaga, Children's Cancer Hospital, Cairo, Egypt; and Juliet P. Hale, Royal Victoria Infirmary NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Matthew J. Murray
- Thomas A. Olson, Emory University, Atlanta, GA; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom; Carlos Rodriguez-Galindo and A. Lindsay Frazier, Boston Children's Hospital, Boston; Carlos Rodriguez-Galindo, A. Lindsay Frazier, and Christopher Sweeney, Dana-Farber Cancer Institute, Boston, MA; Deborah F. Billmore, Riley Hospital for Sick Children, Indianapolis, IN; Mark D. Krailo and Ha M. Dang, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas; David M. Gershenson, University of Texas MD Anderson Cancer Center, Houston, TX; Claire M. Thornton, Royal Victoria Hospital, Belfast, United Kingdom; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom; Sara J. Stoneham, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Daniel Stark, University of Leeds, Leeds, United Kingdom; Furqan Shaikh, The Hospital for Sick Children, Toronto; Allan Covens, University of Toronto, Toronto, Ontario, Canada; Jean Hurteau, University of Chicago Pritzker School of Medicine, Chicago, IL; Sally P. Stenning, Medical Research Council, London, United Kingdom; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Peter S. Grimison, Sydney Cancer Center, Sydney, New South Wales, Australia; Robert A. Huddart, Institute of Cancer Research and Royal Marsden Hospital, Surrey, United Kingdom; Thomas Powles, Barts Cancer Institute, London, United Kingdom; Luiz Fernando Lopes, Barretos Pediatric Cancer Center, São Paulo, Brazil; Simone dos Santos Agular, Centro Infantil Boldrini, Campinas, Brazil; Girish Chinnaswamy, Tata Memorial Hospital, Mumbai, India; Sahar Khaleel and Sherif Abouelnaga, Children's Cancer Hospital, Cairo, Egypt; and Juliet P. Hale, Royal Victoria Infirmary NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Carlos Rodriguez-Galindo
- Thomas A. Olson, Emory University, Atlanta, GA; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom; Carlos Rodriguez-Galindo and A. Lindsay Frazier, Boston Children's Hospital, Boston; Carlos Rodriguez-Galindo, A. Lindsay Frazier, and Christopher Sweeney, Dana-Farber Cancer Institute, Boston, MA; Deborah F. Billmore, Riley Hospital for Sick Children, Indianapolis, IN; Mark D. Krailo and Ha M. Dang, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas; David M. Gershenson, University of Texas MD Anderson Cancer Center, Houston, TX; Claire M. Thornton, Royal Victoria Hospital, Belfast, United Kingdom; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom; Sara J. Stoneham, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Daniel Stark, University of Leeds, Leeds, United Kingdom; Furqan Shaikh, The Hospital for Sick Children, Toronto; Allan Covens, University of Toronto, Toronto, Ontario, Canada; Jean Hurteau, University of Chicago Pritzker School of Medicine, Chicago, IL; Sally P. Stenning, Medical Research Council, London, United Kingdom; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Peter S. Grimison, Sydney Cancer Center, Sydney, New South Wales, Australia; Robert A. Huddart, Institute of Cancer Research and Royal Marsden Hospital, Surrey, United Kingdom; Thomas Powles, Barts Cancer Institute, London, United Kingdom; Luiz Fernando Lopes, Barretos Pediatric Cancer Center, São Paulo, Brazil; Simone dos Santos Agular, Centro Infantil Boldrini, Campinas, Brazil; Girish Chinnaswamy, Tata Memorial Hospital, Mumbai, India; Sahar Khaleel and Sherif Abouelnaga, Children's Cancer Hospital, Cairo, Egypt; and Juliet P. Hale, Royal Victoria Infirmary NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - James C. Nicholson
- Thomas A. Olson, Emory University, Atlanta, GA; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom; Carlos Rodriguez-Galindo and A. Lindsay Frazier, Boston Children's Hospital, Boston; Carlos Rodriguez-Galindo, A. Lindsay Frazier, and Christopher Sweeney, Dana-Farber Cancer Institute, Boston, MA; Deborah F. Billmore, Riley Hospital for Sick Children, Indianapolis, IN; Mark D. Krailo and Ha M. Dang, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas; David M. Gershenson, University of Texas MD Anderson Cancer Center, Houston, TX; Claire M. Thornton, Royal Victoria Hospital, Belfast, United Kingdom; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom; Sara J. Stoneham, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Daniel Stark, University of Leeds, Leeds, United Kingdom; Furqan Shaikh, The Hospital for Sick Children, Toronto; Allan Covens, University of Toronto, Toronto, Ontario, Canada; Jean Hurteau, University of Chicago Pritzker School of Medicine, Chicago, IL; Sally P. Stenning, Medical Research Council, London, United Kingdom; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Peter S. Grimison, Sydney Cancer Center, Sydney, New South Wales, Australia; Robert A. Huddart, Institute of Cancer Research and Royal Marsden Hospital, Surrey, United Kingdom; Thomas Powles, Barts Cancer Institute, London, United Kingdom; Luiz Fernando Lopes, Barretos Pediatric Cancer Center, São Paulo, Brazil; Simone dos Santos Agular, Centro Infantil Boldrini, Campinas, Brazil; Girish Chinnaswamy, Tata Memorial Hospital, Mumbai, India; Sahar Khaleel and Sherif Abouelnaga, Children's Cancer Hospital, Cairo, Egypt; and Juliet P. Hale, Royal Victoria Infirmary NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Deborah F. Billmire
- Thomas A. Olson, Emory University, Atlanta, GA; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom; Carlos Rodriguez-Galindo and A. Lindsay Frazier, Boston Children's Hospital, Boston; Carlos Rodriguez-Galindo, A. Lindsay Frazier, and Christopher Sweeney, Dana-Farber Cancer Institute, Boston, MA; Deborah F. Billmore, Riley Hospital for Sick Children, Indianapolis, IN; Mark D. Krailo and Ha M. Dang, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas; David M. Gershenson, University of Texas MD Anderson Cancer Center, Houston, TX; Claire M. Thornton, Royal Victoria Hospital, Belfast, United Kingdom; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom; Sara J. Stoneham, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Daniel Stark, University of Leeds, Leeds, United Kingdom; Furqan Shaikh, The Hospital for Sick Children, Toronto; Allan Covens, University of Toronto, Toronto, Ontario, Canada; Jean Hurteau, University of Chicago Pritzker School of Medicine, Chicago, IL; Sally P. Stenning, Medical Research Council, London, United Kingdom; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Peter S. Grimison, Sydney Cancer Center, Sydney, New South Wales, Australia; Robert A. Huddart, Institute of Cancer Research and Royal Marsden Hospital, Surrey, United Kingdom; Thomas Powles, Barts Cancer Institute, London, United Kingdom; Luiz Fernando Lopes, Barretos Pediatric Cancer Center, São Paulo, Brazil; Simone dos Santos Agular, Centro Infantil Boldrini, Campinas, Brazil; Girish Chinnaswamy, Tata Memorial Hospital, Mumbai, India; Sahar Khaleel and Sherif Abouelnaga, Children's Cancer Hospital, Cairo, Egypt; and Juliet P. Hale, Royal Victoria Infirmary NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Mark D. Krailo
- Thomas A. Olson, Emory University, Atlanta, GA; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom; Carlos Rodriguez-Galindo and A. Lindsay Frazier, Boston Children's Hospital, Boston; Carlos Rodriguez-Galindo, A. Lindsay Frazier, and Christopher Sweeney, Dana-Farber Cancer Institute, Boston, MA; Deborah F. Billmore, Riley Hospital for Sick Children, Indianapolis, IN; Mark D. Krailo and Ha M. Dang, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas; David M. Gershenson, University of Texas MD Anderson Cancer Center, Houston, TX; Claire M. Thornton, Royal Victoria Hospital, Belfast, United Kingdom; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom; Sara J. Stoneham, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Daniel Stark, University of Leeds, Leeds, United Kingdom; Furqan Shaikh, The Hospital for Sick Children, Toronto; Allan Covens, University of Toronto, Toronto, Ontario, Canada; Jean Hurteau, University of Chicago Pritzker School of Medicine, Chicago, IL; Sally P. Stenning, Medical Research Council, London, United Kingdom; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Peter S. Grimison, Sydney Cancer Center, Sydney, New South Wales, Australia; Robert A. Huddart, Institute of Cancer Research and Royal Marsden Hospital, Surrey, United Kingdom; Thomas Powles, Barts Cancer Institute, London, United Kingdom; Luiz Fernando Lopes, Barretos Pediatric Cancer Center, São Paulo, Brazil; Simone dos Santos Agular, Centro Infantil Boldrini, Campinas, Brazil; Girish Chinnaswamy, Tata Memorial Hospital, Mumbai, India; Sahar Khaleel and Sherif Abouelnaga, Children's Cancer Hospital, Cairo, Egypt; and Juliet P. Hale, Royal Victoria Infirmary NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Ha M. Dang
- Thomas A. Olson, Emory University, Atlanta, GA; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom; Carlos Rodriguez-Galindo and A. Lindsay Frazier, Boston Children's Hospital, Boston; Carlos Rodriguez-Galindo, A. Lindsay Frazier, and Christopher Sweeney, Dana-Farber Cancer Institute, Boston, MA; Deborah F. Billmore, Riley Hospital for Sick Children, Indianapolis, IN; Mark D. Krailo and Ha M. Dang, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas; David M. Gershenson, University of Texas MD Anderson Cancer Center, Houston, TX; Claire M. Thornton, Royal Victoria Hospital, Belfast, United Kingdom; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom; Sara J. Stoneham, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Daniel Stark, University of Leeds, Leeds, United Kingdom; Furqan Shaikh, The Hospital for Sick Children, Toronto; Allan Covens, University of Toronto, Toronto, Ontario, Canada; Jean Hurteau, University of Chicago Pritzker School of Medicine, Chicago, IL; Sally P. Stenning, Medical Research Council, London, United Kingdom; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Peter S. Grimison, Sydney Cancer Center, Sydney, New South Wales, Australia; Robert A. Huddart, Institute of Cancer Research and Royal Marsden Hospital, Surrey, United Kingdom; Thomas Powles, Barts Cancer Institute, London, United Kingdom; Luiz Fernando Lopes, Barretos Pediatric Cancer Center, São Paulo, Brazil; Simone dos Santos Agular, Centro Infantil Boldrini, Campinas, Brazil; Girish Chinnaswamy, Tata Memorial Hospital, Mumbai, India; Sahar Khaleel and Sherif Abouelnaga, Children's Cancer Hospital, Cairo, Egypt; and Juliet P. Hale, Royal Victoria Infirmary NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - James F. Amatruda
- Thomas A. Olson, Emory University, Atlanta, GA; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom; Carlos Rodriguez-Galindo and A. Lindsay Frazier, Boston Children's Hospital, Boston; Carlos Rodriguez-Galindo, A. Lindsay Frazier, and Christopher Sweeney, Dana-Farber Cancer Institute, Boston, MA; Deborah F. Billmore, Riley Hospital for Sick Children, Indianapolis, IN; Mark D. Krailo and Ha M. Dang, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas; David M. Gershenson, University of Texas MD Anderson Cancer Center, Houston, TX; Claire M. Thornton, Royal Victoria Hospital, Belfast, United Kingdom; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom; Sara J. Stoneham, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Daniel Stark, University of Leeds, Leeds, United Kingdom; Furqan Shaikh, The Hospital for Sick Children, Toronto; Allan Covens, University of Toronto, Toronto, Ontario, Canada; Jean Hurteau, University of Chicago Pritzker School of Medicine, Chicago, IL; Sally P. Stenning, Medical Research Council, London, United Kingdom; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Peter S. Grimison, Sydney Cancer Center, Sydney, New South Wales, Australia; Robert A. Huddart, Institute of Cancer Research and Royal Marsden Hospital, Surrey, United Kingdom; Thomas Powles, Barts Cancer Institute, London, United Kingdom; Luiz Fernando Lopes, Barretos Pediatric Cancer Center, São Paulo, Brazil; Simone dos Santos Agular, Centro Infantil Boldrini, Campinas, Brazil; Girish Chinnaswamy, Tata Memorial Hospital, Mumbai, India; Sahar Khaleel and Sherif Abouelnaga, Children's Cancer Hospital, Cairo, Egypt; and Juliet P. Hale, Royal Victoria Infirmary NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Claire M. Thornton
- Thomas A. Olson, Emory University, Atlanta, GA; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom; Carlos Rodriguez-Galindo and A. Lindsay Frazier, Boston Children's Hospital, Boston; Carlos Rodriguez-Galindo, A. Lindsay Frazier, and Christopher Sweeney, Dana-Farber Cancer Institute, Boston, MA; Deborah F. Billmore, Riley Hospital for Sick Children, Indianapolis, IN; Mark D. Krailo and Ha M. Dang, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas; David M. Gershenson, University of Texas MD Anderson Cancer Center, Houston, TX; Claire M. Thornton, Royal Victoria Hospital, Belfast, United Kingdom; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom; Sara J. Stoneham, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Daniel Stark, University of Leeds, Leeds, United Kingdom; Furqan Shaikh, The Hospital for Sick Children, Toronto; Allan Covens, University of Toronto, Toronto, Ontario, Canada; Jean Hurteau, University of Chicago Pritzker School of Medicine, Chicago, IL; Sally P. Stenning, Medical Research Council, London, United Kingdom; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Peter S. Grimison, Sydney Cancer Center, Sydney, New South Wales, Australia; Robert A. Huddart, Institute of Cancer Research and Royal Marsden Hospital, Surrey, United Kingdom; Thomas Powles, Barts Cancer Institute, London, United Kingdom; Luiz Fernando Lopes, Barretos Pediatric Cancer Center, São Paulo, Brazil; Simone dos Santos Agular, Centro Infantil Boldrini, Campinas, Brazil; Girish Chinnaswamy, Tata Memorial Hospital, Mumbai, India; Sahar Khaleel and Sherif Abouelnaga, Children's Cancer Hospital, Cairo, Egypt; and Juliet P. Hale, Royal Victoria Infirmary NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - G. Suren Arul
- Thomas A. Olson, Emory University, Atlanta, GA; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom; Carlos Rodriguez-Galindo and A. Lindsay Frazier, Boston Children's Hospital, Boston; Carlos Rodriguez-Galindo, A. Lindsay Frazier, and Christopher Sweeney, Dana-Farber Cancer Institute, Boston, MA; Deborah F. Billmore, Riley Hospital for Sick Children, Indianapolis, IN; Mark D. Krailo and Ha M. Dang, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas; David M. Gershenson, University of Texas MD Anderson Cancer Center, Houston, TX; Claire M. Thornton, Royal Victoria Hospital, Belfast, United Kingdom; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom; Sara J. Stoneham, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Daniel Stark, University of Leeds, Leeds, United Kingdom; Furqan Shaikh, The Hospital for Sick Children, Toronto; Allan Covens, University of Toronto, Toronto, Ontario, Canada; Jean Hurteau, University of Chicago Pritzker School of Medicine, Chicago, IL; Sally P. Stenning, Medical Research Council, London, United Kingdom; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Peter S. Grimison, Sydney Cancer Center, Sydney, New South Wales, Australia; Robert A. Huddart, Institute of Cancer Research and Royal Marsden Hospital, Surrey, United Kingdom; Thomas Powles, Barts Cancer Institute, London, United Kingdom; Luiz Fernando Lopes, Barretos Pediatric Cancer Center, São Paulo, Brazil; Simone dos Santos Agular, Centro Infantil Boldrini, Campinas, Brazil; Girish Chinnaswamy, Tata Memorial Hospital, Mumbai, India; Sahar Khaleel and Sherif Abouelnaga, Children's Cancer Hospital, Cairo, Egypt; and Juliet P. Hale, Royal Victoria Infirmary NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Sara J. Stoneham
- Thomas A. Olson, Emory University, Atlanta, GA; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom; Carlos Rodriguez-Galindo and A. Lindsay Frazier, Boston Children's Hospital, Boston; Carlos Rodriguez-Galindo, A. Lindsay Frazier, and Christopher Sweeney, Dana-Farber Cancer Institute, Boston, MA; Deborah F. Billmore, Riley Hospital for Sick Children, Indianapolis, IN; Mark D. Krailo and Ha M. Dang, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas; David M. Gershenson, University of Texas MD Anderson Cancer Center, Houston, TX; Claire M. Thornton, Royal Victoria Hospital, Belfast, United Kingdom; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom; Sara J. Stoneham, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Daniel Stark, University of Leeds, Leeds, United Kingdom; Furqan Shaikh, The Hospital for Sick Children, Toronto; Allan Covens, University of Toronto, Toronto, Ontario, Canada; Jean Hurteau, University of Chicago Pritzker School of Medicine, Chicago, IL; Sally P. Stenning, Medical Research Council, London, United Kingdom; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Peter S. Grimison, Sydney Cancer Center, Sydney, New South Wales, Australia; Robert A. Huddart, Institute of Cancer Research and Royal Marsden Hospital, Surrey, United Kingdom; Thomas Powles, Barts Cancer Institute, London, United Kingdom; Luiz Fernando Lopes, Barretos Pediatric Cancer Center, São Paulo, Brazil; Simone dos Santos Agular, Centro Infantil Boldrini, Campinas, Brazil; Girish Chinnaswamy, Tata Memorial Hospital, Mumbai, India; Sahar Khaleel and Sherif Abouelnaga, Children's Cancer Hospital, Cairo, Egypt; and Juliet P. Hale, Royal Victoria Infirmary NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Farzana Pashankar
- Thomas A. Olson, Emory University, Atlanta, GA; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom; Carlos Rodriguez-Galindo and A. Lindsay Frazier, Boston Children's Hospital, Boston; Carlos Rodriguez-Galindo, A. Lindsay Frazier, and Christopher Sweeney, Dana-Farber Cancer Institute, Boston, MA; Deborah F. Billmore, Riley Hospital for Sick Children, Indianapolis, IN; Mark D. Krailo and Ha M. Dang, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas; David M. Gershenson, University of Texas MD Anderson Cancer Center, Houston, TX; Claire M. Thornton, Royal Victoria Hospital, Belfast, United Kingdom; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom; Sara J. Stoneham, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Daniel Stark, University of Leeds, Leeds, United Kingdom; Furqan Shaikh, The Hospital for Sick Children, Toronto; Allan Covens, University of Toronto, Toronto, Ontario, Canada; Jean Hurteau, University of Chicago Pritzker School of Medicine, Chicago, IL; Sally P. Stenning, Medical Research Council, London, United Kingdom; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Peter S. Grimison, Sydney Cancer Center, Sydney, New South Wales, Australia; Robert A. Huddart, Institute of Cancer Research and Royal Marsden Hospital, Surrey, United Kingdom; Thomas Powles, Barts Cancer Institute, London, United Kingdom; Luiz Fernando Lopes, Barretos Pediatric Cancer Center, São Paulo, Brazil; Simone dos Santos Agular, Centro Infantil Boldrini, Campinas, Brazil; Girish Chinnaswamy, Tata Memorial Hospital, Mumbai, India; Sahar Khaleel and Sherif Abouelnaga, Children's Cancer Hospital, Cairo, Egypt; and Juliet P. Hale, Royal Victoria Infirmary NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Daniel Stark
- Thomas A. Olson, Emory University, Atlanta, GA; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom; Carlos Rodriguez-Galindo and A. Lindsay Frazier, Boston Children's Hospital, Boston; Carlos Rodriguez-Galindo, A. Lindsay Frazier, and Christopher Sweeney, Dana-Farber Cancer Institute, Boston, MA; Deborah F. Billmore, Riley Hospital for Sick Children, Indianapolis, IN; Mark D. Krailo and Ha M. Dang, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas; David M. Gershenson, University of Texas MD Anderson Cancer Center, Houston, TX; Claire M. Thornton, Royal Victoria Hospital, Belfast, United Kingdom; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom; Sara J. Stoneham, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Daniel Stark, University of Leeds, Leeds, United Kingdom; Furqan Shaikh, The Hospital for Sick Children, Toronto; Allan Covens, University of Toronto, Toronto, Ontario, Canada; Jean Hurteau, University of Chicago Pritzker School of Medicine, Chicago, IL; Sally P. Stenning, Medical Research Council, London, United Kingdom; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Peter S. Grimison, Sydney Cancer Center, Sydney, New South Wales, Australia; Robert A. Huddart, Institute of Cancer Research and Royal Marsden Hospital, Surrey, United Kingdom; Thomas Powles, Barts Cancer Institute, London, United Kingdom; Luiz Fernando Lopes, Barretos Pediatric Cancer Center, São Paulo, Brazil; Simone dos Santos Agular, Centro Infantil Boldrini, Campinas, Brazil; Girish Chinnaswamy, Tata Memorial Hospital, Mumbai, India; Sahar Khaleel and Sherif Abouelnaga, Children's Cancer Hospital, Cairo, Egypt; and Juliet P. Hale, Royal Victoria Infirmary NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Furqan Shaikh
- Thomas A. Olson, Emory University, Atlanta, GA; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom; Carlos Rodriguez-Galindo and A. Lindsay Frazier, Boston Children's Hospital, Boston; Carlos Rodriguez-Galindo, A. Lindsay Frazier, and Christopher Sweeney, Dana-Farber Cancer Institute, Boston, MA; Deborah F. Billmore, Riley Hospital for Sick Children, Indianapolis, IN; Mark D. Krailo and Ha M. Dang, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas; David M. Gershenson, University of Texas MD Anderson Cancer Center, Houston, TX; Claire M. Thornton, Royal Victoria Hospital, Belfast, United Kingdom; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom; Sara J. Stoneham, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Daniel Stark, University of Leeds, Leeds, United Kingdom; Furqan Shaikh, The Hospital for Sick Children, Toronto; Allan Covens, University of Toronto, Toronto, Ontario, Canada; Jean Hurteau, University of Chicago Pritzker School of Medicine, Chicago, IL; Sally P. Stenning, Medical Research Council, London, United Kingdom; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Peter S. Grimison, Sydney Cancer Center, Sydney, New South Wales, Australia; Robert A. Huddart, Institute of Cancer Research and Royal Marsden Hospital, Surrey, United Kingdom; Thomas Powles, Barts Cancer Institute, London, United Kingdom; Luiz Fernando Lopes, Barretos Pediatric Cancer Center, São Paulo, Brazil; Simone dos Santos Agular, Centro Infantil Boldrini, Campinas, Brazil; Girish Chinnaswamy, Tata Memorial Hospital, Mumbai, India; Sahar Khaleel and Sherif Abouelnaga, Children's Cancer Hospital, Cairo, Egypt; and Juliet P. Hale, Royal Victoria Infirmary NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - David M. Gershenson
- Thomas A. Olson, Emory University, Atlanta, GA; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom; Carlos Rodriguez-Galindo and A. Lindsay Frazier, Boston Children's Hospital, Boston; Carlos Rodriguez-Galindo, A. Lindsay Frazier, and Christopher Sweeney, Dana-Farber Cancer Institute, Boston, MA; Deborah F. Billmore, Riley Hospital for Sick Children, Indianapolis, IN; Mark D. Krailo and Ha M. Dang, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas; David M. Gershenson, University of Texas MD Anderson Cancer Center, Houston, TX; Claire M. Thornton, Royal Victoria Hospital, Belfast, United Kingdom; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom; Sara J. Stoneham, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Daniel Stark, University of Leeds, Leeds, United Kingdom; Furqan Shaikh, The Hospital for Sick Children, Toronto; Allan Covens, University of Toronto, Toronto, Ontario, Canada; Jean Hurteau, University of Chicago Pritzker School of Medicine, Chicago, IL; Sally P. Stenning, Medical Research Council, London, United Kingdom; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Peter S. Grimison, Sydney Cancer Center, Sydney, New South Wales, Australia; Robert A. Huddart, Institute of Cancer Research and Royal Marsden Hospital, Surrey, United Kingdom; Thomas Powles, Barts Cancer Institute, London, United Kingdom; Luiz Fernando Lopes, Barretos Pediatric Cancer Center, São Paulo, Brazil; Simone dos Santos Agular, Centro Infantil Boldrini, Campinas, Brazil; Girish Chinnaswamy, Tata Memorial Hospital, Mumbai, India; Sahar Khaleel and Sherif Abouelnaga, Children's Cancer Hospital, Cairo, Egypt; and Juliet P. Hale, Royal Victoria Infirmary NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Allan Covens
- Thomas A. Olson, Emory University, Atlanta, GA; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom; Carlos Rodriguez-Galindo and A. Lindsay Frazier, Boston Children's Hospital, Boston; Carlos Rodriguez-Galindo, A. Lindsay Frazier, and Christopher Sweeney, Dana-Farber Cancer Institute, Boston, MA; Deborah F. Billmore, Riley Hospital for Sick Children, Indianapolis, IN; Mark D. Krailo and Ha M. Dang, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas; David M. Gershenson, University of Texas MD Anderson Cancer Center, Houston, TX; Claire M. Thornton, Royal Victoria Hospital, Belfast, United Kingdom; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom; Sara J. Stoneham, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Daniel Stark, University of Leeds, Leeds, United Kingdom; Furqan Shaikh, The Hospital for Sick Children, Toronto; Allan Covens, University of Toronto, Toronto, Ontario, Canada; Jean Hurteau, University of Chicago Pritzker School of Medicine, Chicago, IL; Sally P. Stenning, Medical Research Council, London, United Kingdom; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Peter S. Grimison, Sydney Cancer Center, Sydney, New South Wales, Australia; Robert A. Huddart, Institute of Cancer Research and Royal Marsden Hospital, Surrey, United Kingdom; Thomas Powles, Barts Cancer Institute, London, United Kingdom; Luiz Fernando Lopes, Barretos Pediatric Cancer Center, São Paulo, Brazil; Simone dos Santos Agular, Centro Infantil Boldrini, Campinas, Brazil; Girish Chinnaswamy, Tata Memorial Hospital, Mumbai, India; Sahar Khaleel and Sherif Abouelnaga, Children's Cancer Hospital, Cairo, Egypt; and Juliet P. Hale, Royal Victoria Infirmary NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Jean Hurteau
- Thomas A. Olson, Emory University, Atlanta, GA; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom; Carlos Rodriguez-Galindo and A. Lindsay Frazier, Boston Children's Hospital, Boston; Carlos Rodriguez-Galindo, A. Lindsay Frazier, and Christopher Sweeney, Dana-Farber Cancer Institute, Boston, MA; Deborah F. Billmore, Riley Hospital for Sick Children, Indianapolis, IN; Mark D. Krailo and Ha M. Dang, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas; David M. Gershenson, University of Texas MD Anderson Cancer Center, Houston, TX; Claire M. Thornton, Royal Victoria Hospital, Belfast, United Kingdom; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom; Sara J. Stoneham, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Daniel Stark, University of Leeds, Leeds, United Kingdom; Furqan Shaikh, The Hospital for Sick Children, Toronto; Allan Covens, University of Toronto, Toronto, Ontario, Canada; Jean Hurteau, University of Chicago Pritzker School of Medicine, Chicago, IL; Sally P. Stenning, Medical Research Council, London, United Kingdom; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Peter S. Grimison, Sydney Cancer Center, Sydney, New South Wales, Australia; Robert A. Huddart, Institute of Cancer Research and Royal Marsden Hospital, Surrey, United Kingdom; Thomas Powles, Barts Cancer Institute, London, United Kingdom; Luiz Fernando Lopes, Barretos Pediatric Cancer Center, São Paulo, Brazil; Simone dos Santos Agular, Centro Infantil Boldrini, Campinas, Brazil; Girish Chinnaswamy, Tata Memorial Hospital, Mumbai, India; Sahar Khaleel and Sherif Abouelnaga, Children's Cancer Hospital, Cairo, Egypt; and Juliet P. Hale, Royal Victoria Infirmary NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Sally P. Stenning
- Thomas A. Olson, Emory University, Atlanta, GA; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom; Carlos Rodriguez-Galindo and A. Lindsay Frazier, Boston Children's Hospital, Boston; Carlos Rodriguez-Galindo, A. Lindsay Frazier, and Christopher Sweeney, Dana-Farber Cancer Institute, Boston, MA; Deborah F. Billmore, Riley Hospital for Sick Children, Indianapolis, IN; Mark D. Krailo and Ha M. Dang, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas; David M. Gershenson, University of Texas MD Anderson Cancer Center, Houston, TX; Claire M. Thornton, Royal Victoria Hospital, Belfast, United Kingdom; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom; Sara J. Stoneham, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Daniel Stark, University of Leeds, Leeds, United Kingdom; Furqan Shaikh, The Hospital for Sick Children, Toronto; Allan Covens, University of Toronto, Toronto, Ontario, Canada; Jean Hurteau, University of Chicago Pritzker School of Medicine, Chicago, IL; Sally P. Stenning, Medical Research Council, London, United Kingdom; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Peter S. Grimison, Sydney Cancer Center, Sydney, New South Wales, Australia; Robert A. Huddart, Institute of Cancer Research and Royal Marsden Hospital, Surrey, United Kingdom; Thomas Powles, Barts Cancer Institute, London, United Kingdom; Luiz Fernando Lopes, Barretos Pediatric Cancer Center, São Paulo, Brazil; Simone dos Santos Agular, Centro Infantil Boldrini, Campinas, Brazil; Girish Chinnaswamy, Tata Memorial Hospital, Mumbai, India; Sahar Khaleel and Sherif Abouelnaga, Children's Cancer Hospital, Cairo, Egypt; and Juliet P. Hale, Royal Victoria Infirmary NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Darren R. Feldman
- Thomas A. Olson, Emory University, Atlanta, GA; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom; Carlos Rodriguez-Galindo and A. Lindsay Frazier, Boston Children's Hospital, Boston; Carlos Rodriguez-Galindo, A. Lindsay Frazier, and Christopher Sweeney, Dana-Farber Cancer Institute, Boston, MA; Deborah F. Billmore, Riley Hospital for Sick Children, Indianapolis, IN; Mark D. Krailo and Ha M. Dang, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas; David M. Gershenson, University of Texas MD Anderson Cancer Center, Houston, TX; Claire M. Thornton, Royal Victoria Hospital, Belfast, United Kingdom; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom; Sara J. Stoneham, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Daniel Stark, University of Leeds, Leeds, United Kingdom; Furqan Shaikh, The Hospital for Sick Children, Toronto; Allan Covens, University of Toronto, Toronto, Ontario, Canada; Jean Hurteau, University of Chicago Pritzker School of Medicine, Chicago, IL; Sally P. Stenning, Medical Research Council, London, United Kingdom; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Peter S. Grimison, Sydney Cancer Center, Sydney, New South Wales, Australia; Robert A. Huddart, Institute of Cancer Research and Royal Marsden Hospital, Surrey, United Kingdom; Thomas Powles, Barts Cancer Institute, London, United Kingdom; Luiz Fernando Lopes, Barretos Pediatric Cancer Center, São Paulo, Brazil; Simone dos Santos Agular, Centro Infantil Boldrini, Campinas, Brazil; Girish Chinnaswamy, Tata Memorial Hospital, Mumbai, India; Sahar Khaleel and Sherif Abouelnaga, Children's Cancer Hospital, Cairo, Egypt; and Juliet P. Hale, Royal Victoria Infirmary NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Peter S. Grimison
- Thomas A. Olson, Emory University, Atlanta, GA; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom; Carlos Rodriguez-Galindo and A. Lindsay Frazier, Boston Children's Hospital, Boston; Carlos Rodriguez-Galindo, A. Lindsay Frazier, and Christopher Sweeney, Dana-Farber Cancer Institute, Boston, MA; Deborah F. Billmore, Riley Hospital for Sick Children, Indianapolis, IN; Mark D. Krailo and Ha M. Dang, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas; David M. Gershenson, University of Texas MD Anderson Cancer Center, Houston, TX; Claire M. Thornton, Royal Victoria Hospital, Belfast, United Kingdom; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom; Sara J. Stoneham, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Daniel Stark, University of Leeds, Leeds, United Kingdom; Furqan Shaikh, The Hospital for Sick Children, Toronto; Allan Covens, University of Toronto, Toronto, Ontario, Canada; Jean Hurteau, University of Chicago Pritzker School of Medicine, Chicago, IL; Sally P. Stenning, Medical Research Council, London, United Kingdom; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Peter S. Grimison, Sydney Cancer Center, Sydney, New South Wales, Australia; Robert A. Huddart, Institute of Cancer Research and Royal Marsden Hospital, Surrey, United Kingdom; Thomas Powles, Barts Cancer Institute, London, United Kingdom; Luiz Fernando Lopes, Barretos Pediatric Cancer Center, São Paulo, Brazil; Simone dos Santos Agular, Centro Infantil Boldrini, Campinas, Brazil; Girish Chinnaswamy, Tata Memorial Hospital, Mumbai, India; Sahar Khaleel and Sherif Abouelnaga, Children's Cancer Hospital, Cairo, Egypt; and Juliet P. Hale, Royal Victoria Infirmary NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Robert A. Huddart
- Thomas A. Olson, Emory University, Atlanta, GA; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom; Carlos Rodriguez-Galindo and A. Lindsay Frazier, Boston Children's Hospital, Boston; Carlos Rodriguez-Galindo, A. Lindsay Frazier, and Christopher Sweeney, Dana-Farber Cancer Institute, Boston, MA; Deborah F. Billmore, Riley Hospital for Sick Children, Indianapolis, IN; Mark D. Krailo and Ha M. Dang, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas; David M. Gershenson, University of Texas MD Anderson Cancer Center, Houston, TX; Claire M. Thornton, Royal Victoria Hospital, Belfast, United Kingdom; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom; Sara J. Stoneham, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Daniel Stark, University of Leeds, Leeds, United Kingdom; Furqan Shaikh, The Hospital for Sick Children, Toronto; Allan Covens, University of Toronto, Toronto, Ontario, Canada; Jean Hurteau, University of Chicago Pritzker School of Medicine, Chicago, IL; Sally P. Stenning, Medical Research Council, London, United Kingdom; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Peter S. Grimison, Sydney Cancer Center, Sydney, New South Wales, Australia; Robert A. Huddart, Institute of Cancer Research and Royal Marsden Hospital, Surrey, United Kingdom; Thomas Powles, Barts Cancer Institute, London, United Kingdom; Luiz Fernando Lopes, Barretos Pediatric Cancer Center, São Paulo, Brazil; Simone dos Santos Agular, Centro Infantil Boldrini, Campinas, Brazil; Girish Chinnaswamy, Tata Memorial Hospital, Mumbai, India; Sahar Khaleel and Sherif Abouelnaga, Children's Cancer Hospital, Cairo, Egypt; and Juliet P. Hale, Royal Victoria Infirmary NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Christopher Sweeney
- Thomas A. Olson, Emory University, Atlanta, GA; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom; Carlos Rodriguez-Galindo and A. Lindsay Frazier, Boston Children's Hospital, Boston; Carlos Rodriguez-Galindo, A. Lindsay Frazier, and Christopher Sweeney, Dana-Farber Cancer Institute, Boston, MA; Deborah F. Billmore, Riley Hospital for Sick Children, Indianapolis, IN; Mark D. Krailo and Ha M. Dang, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas; David M. Gershenson, University of Texas MD Anderson Cancer Center, Houston, TX; Claire M. Thornton, Royal Victoria Hospital, Belfast, United Kingdom; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom; Sara J. Stoneham, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Daniel Stark, University of Leeds, Leeds, United Kingdom; Furqan Shaikh, The Hospital for Sick Children, Toronto; Allan Covens, University of Toronto, Toronto, Ontario, Canada; Jean Hurteau, University of Chicago Pritzker School of Medicine, Chicago, IL; Sally P. Stenning, Medical Research Council, London, United Kingdom; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Peter S. Grimison, Sydney Cancer Center, Sydney, New South Wales, Australia; Robert A. Huddart, Institute of Cancer Research and Royal Marsden Hospital, Surrey, United Kingdom; Thomas Powles, Barts Cancer Institute, London, United Kingdom; Luiz Fernando Lopes, Barretos Pediatric Cancer Center, São Paulo, Brazil; Simone dos Santos Agular, Centro Infantil Boldrini, Campinas, Brazil; Girish Chinnaswamy, Tata Memorial Hospital, Mumbai, India; Sahar Khaleel and Sherif Abouelnaga, Children's Cancer Hospital, Cairo, Egypt; and Juliet P. Hale, Royal Victoria Infirmary NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Thomas Powles
- Thomas A. Olson, Emory University, Atlanta, GA; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom; Carlos Rodriguez-Galindo and A. Lindsay Frazier, Boston Children's Hospital, Boston; Carlos Rodriguez-Galindo, A. Lindsay Frazier, and Christopher Sweeney, Dana-Farber Cancer Institute, Boston, MA; Deborah F. Billmore, Riley Hospital for Sick Children, Indianapolis, IN; Mark D. Krailo and Ha M. Dang, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas; David M. Gershenson, University of Texas MD Anderson Cancer Center, Houston, TX; Claire M. Thornton, Royal Victoria Hospital, Belfast, United Kingdom; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom; Sara J. Stoneham, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Daniel Stark, University of Leeds, Leeds, United Kingdom; Furqan Shaikh, The Hospital for Sick Children, Toronto; Allan Covens, University of Toronto, Toronto, Ontario, Canada; Jean Hurteau, University of Chicago Pritzker School of Medicine, Chicago, IL; Sally P. Stenning, Medical Research Council, London, United Kingdom; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Peter S. Grimison, Sydney Cancer Center, Sydney, New South Wales, Australia; Robert A. Huddart, Institute of Cancer Research and Royal Marsden Hospital, Surrey, United Kingdom; Thomas Powles, Barts Cancer Institute, London, United Kingdom; Luiz Fernando Lopes, Barretos Pediatric Cancer Center, São Paulo, Brazil; Simone dos Santos Agular, Centro Infantil Boldrini, Campinas, Brazil; Girish Chinnaswamy, Tata Memorial Hospital, Mumbai, India; Sahar Khaleel and Sherif Abouelnaga, Children's Cancer Hospital, Cairo, Egypt; and Juliet P. Hale, Royal Victoria Infirmary NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Luiz Fernando Lopes
- Thomas A. Olson, Emory University, Atlanta, GA; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom; Carlos Rodriguez-Galindo and A. Lindsay Frazier, Boston Children's Hospital, Boston; Carlos Rodriguez-Galindo, A. Lindsay Frazier, and Christopher Sweeney, Dana-Farber Cancer Institute, Boston, MA; Deborah F. Billmore, Riley Hospital for Sick Children, Indianapolis, IN; Mark D. Krailo and Ha M. Dang, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas; David M. Gershenson, University of Texas MD Anderson Cancer Center, Houston, TX; Claire M. Thornton, Royal Victoria Hospital, Belfast, United Kingdom; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom; Sara J. Stoneham, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Daniel Stark, University of Leeds, Leeds, United Kingdom; Furqan Shaikh, The Hospital for Sick Children, Toronto; Allan Covens, University of Toronto, Toronto, Ontario, Canada; Jean Hurteau, University of Chicago Pritzker School of Medicine, Chicago, IL; Sally P. Stenning, Medical Research Council, London, United Kingdom; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Peter S. Grimison, Sydney Cancer Center, Sydney, New South Wales, Australia; Robert A. Huddart, Institute of Cancer Research and Royal Marsden Hospital, Surrey, United Kingdom; Thomas Powles, Barts Cancer Institute, London, United Kingdom; Luiz Fernando Lopes, Barretos Pediatric Cancer Center, São Paulo, Brazil; Simone dos Santos Agular, Centro Infantil Boldrini, Campinas, Brazil; Girish Chinnaswamy, Tata Memorial Hospital, Mumbai, India; Sahar Khaleel and Sherif Abouelnaga, Children's Cancer Hospital, Cairo, Egypt; and Juliet P. Hale, Royal Victoria Infirmary NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Simone dos Santos Agular
- Thomas A. Olson, Emory University, Atlanta, GA; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom; Carlos Rodriguez-Galindo and A. Lindsay Frazier, Boston Children's Hospital, Boston; Carlos Rodriguez-Galindo, A. Lindsay Frazier, and Christopher Sweeney, Dana-Farber Cancer Institute, Boston, MA; Deborah F. Billmore, Riley Hospital for Sick Children, Indianapolis, IN; Mark D. Krailo and Ha M. Dang, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas; David M. Gershenson, University of Texas MD Anderson Cancer Center, Houston, TX; Claire M. Thornton, Royal Victoria Hospital, Belfast, United Kingdom; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom; Sara J. Stoneham, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Daniel Stark, University of Leeds, Leeds, United Kingdom; Furqan Shaikh, The Hospital for Sick Children, Toronto; Allan Covens, University of Toronto, Toronto, Ontario, Canada; Jean Hurteau, University of Chicago Pritzker School of Medicine, Chicago, IL; Sally P. Stenning, Medical Research Council, London, United Kingdom; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Peter S. Grimison, Sydney Cancer Center, Sydney, New South Wales, Australia; Robert A. Huddart, Institute of Cancer Research and Royal Marsden Hospital, Surrey, United Kingdom; Thomas Powles, Barts Cancer Institute, London, United Kingdom; Luiz Fernando Lopes, Barretos Pediatric Cancer Center, São Paulo, Brazil; Simone dos Santos Agular, Centro Infantil Boldrini, Campinas, Brazil; Girish Chinnaswamy, Tata Memorial Hospital, Mumbai, India; Sahar Khaleel and Sherif Abouelnaga, Children's Cancer Hospital, Cairo, Egypt; and Juliet P. Hale, Royal Victoria Infirmary NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Girish Chinnaswamy
- Thomas A. Olson, Emory University, Atlanta, GA; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom; Carlos Rodriguez-Galindo and A. Lindsay Frazier, Boston Children's Hospital, Boston; Carlos Rodriguez-Galindo, A. Lindsay Frazier, and Christopher Sweeney, Dana-Farber Cancer Institute, Boston, MA; Deborah F. Billmore, Riley Hospital for Sick Children, Indianapolis, IN; Mark D. Krailo and Ha M. Dang, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas; David M. Gershenson, University of Texas MD Anderson Cancer Center, Houston, TX; Claire M. Thornton, Royal Victoria Hospital, Belfast, United Kingdom; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom; Sara J. Stoneham, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Daniel Stark, University of Leeds, Leeds, United Kingdom; Furqan Shaikh, The Hospital for Sick Children, Toronto; Allan Covens, University of Toronto, Toronto, Ontario, Canada; Jean Hurteau, University of Chicago Pritzker School of Medicine, Chicago, IL; Sally P. Stenning, Medical Research Council, London, United Kingdom; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Peter S. Grimison, Sydney Cancer Center, Sydney, New South Wales, Australia; Robert A. Huddart, Institute of Cancer Research and Royal Marsden Hospital, Surrey, United Kingdom; Thomas Powles, Barts Cancer Institute, London, United Kingdom; Luiz Fernando Lopes, Barretos Pediatric Cancer Center, São Paulo, Brazil; Simone dos Santos Agular, Centro Infantil Boldrini, Campinas, Brazil; Girish Chinnaswamy, Tata Memorial Hospital, Mumbai, India; Sahar Khaleel and Sherif Abouelnaga, Children's Cancer Hospital, Cairo, Egypt; and Juliet P. Hale, Royal Victoria Infirmary NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Sahar Khaleel
- Thomas A. Olson, Emory University, Atlanta, GA; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom; Carlos Rodriguez-Galindo and A. Lindsay Frazier, Boston Children's Hospital, Boston; Carlos Rodriguez-Galindo, A. Lindsay Frazier, and Christopher Sweeney, Dana-Farber Cancer Institute, Boston, MA; Deborah F. Billmore, Riley Hospital for Sick Children, Indianapolis, IN; Mark D. Krailo and Ha M. Dang, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas; David M. Gershenson, University of Texas MD Anderson Cancer Center, Houston, TX; Claire M. Thornton, Royal Victoria Hospital, Belfast, United Kingdom; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom; Sara J. Stoneham, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Daniel Stark, University of Leeds, Leeds, United Kingdom; Furqan Shaikh, The Hospital for Sick Children, Toronto; Allan Covens, University of Toronto, Toronto, Ontario, Canada; Jean Hurteau, University of Chicago Pritzker School of Medicine, Chicago, IL; Sally P. Stenning, Medical Research Council, London, United Kingdom; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Peter S. Grimison, Sydney Cancer Center, Sydney, New South Wales, Australia; Robert A. Huddart, Institute of Cancer Research and Royal Marsden Hospital, Surrey, United Kingdom; Thomas Powles, Barts Cancer Institute, London, United Kingdom; Luiz Fernando Lopes, Barretos Pediatric Cancer Center, São Paulo, Brazil; Simone dos Santos Agular, Centro Infantil Boldrini, Campinas, Brazil; Girish Chinnaswamy, Tata Memorial Hospital, Mumbai, India; Sahar Khaleel and Sherif Abouelnaga, Children's Cancer Hospital, Cairo, Egypt; and Juliet P. Hale, Royal Victoria Infirmary NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Sherif Abouelnaga
- Thomas A. Olson, Emory University, Atlanta, GA; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom; Carlos Rodriguez-Galindo and A. Lindsay Frazier, Boston Children's Hospital, Boston; Carlos Rodriguez-Galindo, A. Lindsay Frazier, and Christopher Sweeney, Dana-Farber Cancer Institute, Boston, MA; Deborah F. Billmore, Riley Hospital for Sick Children, Indianapolis, IN; Mark D. Krailo and Ha M. Dang, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas; David M. Gershenson, University of Texas MD Anderson Cancer Center, Houston, TX; Claire M. Thornton, Royal Victoria Hospital, Belfast, United Kingdom; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom; Sara J. Stoneham, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Daniel Stark, University of Leeds, Leeds, United Kingdom; Furqan Shaikh, The Hospital for Sick Children, Toronto; Allan Covens, University of Toronto, Toronto, Ontario, Canada; Jean Hurteau, University of Chicago Pritzker School of Medicine, Chicago, IL; Sally P. Stenning, Medical Research Council, London, United Kingdom; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Peter S. Grimison, Sydney Cancer Center, Sydney, New South Wales, Australia; Robert A. Huddart, Institute of Cancer Research and Royal Marsden Hospital, Surrey, United Kingdom; Thomas Powles, Barts Cancer Institute, London, United Kingdom; Luiz Fernando Lopes, Barretos Pediatric Cancer Center, São Paulo, Brazil; Simone dos Santos Agular, Centro Infantil Boldrini, Campinas, Brazil; Girish Chinnaswamy, Tata Memorial Hospital, Mumbai, India; Sahar Khaleel and Sherif Abouelnaga, Children's Cancer Hospital, Cairo, Egypt; and Juliet P. Hale, Royal Victoria Infirmary NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Juliet P. Hale
- Thomas A. Olson, Emory University, Atlanta, GA; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom; Carlos Rodriguez-Galindo and A. Lindsay Frazier, Boston Children's Hospital, Boston; Carlos Rodriguez-Galindo, A. Lindsay Frazier, and Christopher Sweeney, Dana-Farber Cancer Institute, Boston, MA; Deborah F. Billmore, Riley Hospital for Sick Children, Indianapolis, IN; Mark D. Krailo and Ha M. Dang, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas; David M. Gershenson, University of Texas MD Anderson Cancer Center, Houston, TX; Claire M. Thornton, Royal Victoria Hospital, Belfast, United Kingdom; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom; Sara J. Stoneham, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Daniel Stark, University of Leeds, Leeds, United Kingdom; Furqan Shaikh, The Hospital for Sick Children, Toronto; Allan Covens, University of Toronto, Toronto, Ontario, Canada; Jean Hurteau, University of Chicago Pritzker School of Medicine, Chicago, IL; Sally P. Stenning, Medical Research Council, London, United Kingdom; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Peter S. Grimison, Sydney Cancer Center, Sydney, New South Wales, Australia; Robert A. Huddart, Institute of Cancer Research and Royal Marsden Hospital, Surrey, United Kingdom; Thomas Powles, Barts Cancer Institute, London, United Kingdom; Luiz Fernando Lopes, Barretos Pediatric Cancer Center, São Paulo, Brazil; Simone dos Santos Agular, Centro Infantil Boldrini, Campinas, Brazil; Girish Chinnaswamy, Tata Memorial Hospital, Mumbai, India; Sahar Khaleel and Sherif Abouelnaga, Children's Cancer Hospital, Cairo, Egypt; and Juliet P. Hale, Royal Victoria Infirmary NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - A. Lindsay Frazier
- Thomas A. Olson, Emory University, Atlanta, GA; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom; Carlos Rodriguez-Galindo and A. Lindsay Frazier, Boston Children's Hospital, Boston; Carlos Rodriguez-Galindo, A. Lindsay Frazier, and Christopher Sweeney, Dana-Farber Cancer Institute, Boston, MA; Deborah F. Billmore, Riley Hospital for Sick Children, Indianapolis, IN; Mark D. Krailo and Ha M. Dang, University of Southern California, Los Angeles, CA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas; David M. Gershenson, University of Texas MD Anderson Cancer Center, Houston, TX; Claire M. Thornton, Royal Victoria Hospital, Belfast, United Kingdom; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom; Sara J. Stoneham, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Farzana Pashankar, Yale University School of Medicine, New Haven, CT; Daniel Stark, University of Leeds, Leeds, United Kingdom; Furqan Shaikh, The Hospital for Sick Children, Toronto; Allan Covens, University of Toronto, Toronto, Ontario, Canada; Jean Hurteau, University of Chicago Pritzker School of Medicine, Chicago, IL; Sally P. Stenning, Medical Research Council, London, United Kingdom; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Peter S. Grimison, Sydney Cancer Center, Sydney, New South Wales, Australia; Robert A. Huddart, Institute of Cancer Research and Royal Marsden Hospital, Surrey, United Kingdom; Thomas Powles, Barts Cancer Institute, London, United Kingdom; Luiz Fernando Lopes, Barretos Pediatric Cancer Center, São Paulo, Brazil; Simone dos Santos Agular, Centro Infantil Boldrini, Campinas, Brazil; Girish Chinnaswamy, Tata Memorial Hospital, Mumbai, India; Sahar Khaleel and Sherif Abouelnaga, Children's Cancer Hospital, Cairo, Egypt; and Juliet P. Hale, Royal Victoria Infirmary NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
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Frazier AL, Hale JP, Rodriguez-Galindo C, Dang H, Olson T, Murray MJ, Amatruda JF, Thornton C, Arul GS, Billmire D, Shaikh F, Pashankar F, Stoneham S, Krailo M, Nicholson JC. Revised risk classification for pediatric extracranial germ cell tumors based on 25 years of clinical trial data from the United Kingdom and United States. J Clin Oncol 2015; 33:195-201. [PMID: 25452439 PMCID: PMC4279239 DOI: 10.1200/jco.2014.58.3369] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To risk stratify malignant extracranial pediatric germ cell tumors (GCTs). PATIENTS AND METHODS Data from seven GCT trials conducted by the Children's Oncology Group (United States) or the Children's Cancer and Leukemia Group (United Kingdom) between 1985 and 2009 were merged to create a data set of patients with stage II to IV disease treated with platinum-based therapy. A parametric cure model was used to evaluate the prognostic importance of age, tumor site, stage, histology, tumor markers, and treatment regimen and estimate the percentage of patients who achieved long-term disease-free (LTDF) survival in each subgroup of the final model. Validation of the model was conducted using the bootstrap method. RESULTS In multivariable analysis of 519 patients with GCTs, stage IV disease (P = .001), age ≥ 11 years (P < .001), and tumor site (P < .001) were significant predictors of worse LTDF survival. Elevated alpha-fetoprotein (AFP) ≥ 10,000 ng/mL was associated with worse outcome, whereas pure yolk sac tumor (YST) was associated with better outcome, although neither met criteria for statistical significance. The analysis identified a group of patients age > 11 years with either stage III to IV extragonadal tumors or stage IV ovarian tumors with predicted LTDF survival < 70%. A bootstrap procedure showed retention of age, tumor site, and stage in > 94%, AFP in 12%, and YST in 27% of the replications. CONCLUSION Clinical trial data from two large national pediatric clinical trial organizations have produced a new evidence-based risk stratification of malignant pediatric GCTs that identifies a poor-risk group warranting intensified therapy.
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Affiliation(s)
- A Lindsay Frazier
- A. Lindsay Frazier and Carlos Rodriguez-Galindo, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA; Juliet P. Hale, Newcastle upon Tyne Hospitals National Health Service (NHS) Foundation Trust, Newcastle upon Tyne; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals NHS Foundation Trust; Matthew J. Murray, University of Cambridge, Cambridge; Claire Thornton, Royal Victoria Hospital, Belfast Health Trust, Belfast; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birgmingham; Sara Stoneham, Children's and Young Persons Cancer Services, University College London Hospital Trusts, London, United Kingdom; Ha Dang, Children's Oncology Group; Mark Krailo, University of Southern California, Los Angeles, CA; Thomas Olson, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center Dallas, Dallas, TX; Deborah Billmire, Riley Hospital for Children, Indianapolis, IN; Furqan Shaikh, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; and Farzana Pashankar, Yale Cancer Center, New Haven, CT.
| | - Juliet P Hale
- A. Lindsay Frazier and Carlos Rodriguez-Galindo, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA; Juliet P. Hale, Newcastle upon Tyne Hospitals National Health Service (NHS) Foundation Trust, Newcastle upon Tyne; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals NHS Foundation Trust; Matthew J. Murray, University of Cambridge, Cambridge; Claire Thornton, Royal Victoria Hospital, Belfast Health Trust, Belfast; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birgmingham; Sara Stoneham, Children's and Young Persons Cancer Services, University College London Hospital Trusts, London, United Kingdom; Ha Dang, Children's Oncology Group; Mark Krailo, University of Southern California, Los Angeles, CA; Thomas Olson, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center Dallas, Dallas, TX; Deborah Billmire, Riley Hospital for Children, Indianapolis, IN; Furqan Shaikh, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; and Farzana Pashankar, Yale Cancer Center, New Haven, CT
| | - Carlos Rodriguez-Galindo
- A. Lindsay Frazier and Carlos Rodriguez-Galindo, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA; Juliet P. Hale, Newcastle upon Tyne Hospitals National Health Service (NHS) Foundation Trust, Newcastle upon Tyne; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals NHS Foundation Trust; Matthew J. Murray, University of Cambridge, Cambridge; Claire Thornton, Royal Victoria Hospital, Belfast Health Trust, Belfast; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birgmingham; Sara Stoneham, Children's and Young Persons Cancer Services, University College London Hospital Trusts, London, United Kingdom; Ha Dang, Children's Oncology Group; Mark Krailo, University of Southern California, Los Angeles, CA; Thomas Olson, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center Dallas, Dallas, TX; Deborah Billmire, Riley Hospital for Children, Indianapolis, IN; Furqan Shaikh, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; and Farzana Pashankar, Yale Cancer Center, New Haven, CT
| | - Ha Dang
- A. Lindsay Frazier and Carlos Rodriguez-Galindo, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA; Juliet P. Hale, Newcastle upon Tyne Hospitals National Health Service (NHS) Foundation Trust, Newcastle upon Tyne; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals NHS Foundation Trust; Matthew J. Murray, University of Cambridge, Cambridge; Claire Thornton, Royal Victoria Hospital, Belfast Health Trust, Belfast; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birgmingham; Sara Stoneham, Children's and Young Persons Cancer Services, University College London Hospital Trusts, London, United Kingdom; Ha Dang, Children's Oncology Group; Mark Krailo, University of Southern California, Los Angeles, CA; Thomas Olson, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center Dallas, Dallas, TX; Deborah Billmire, Riley Hospital for Children, Indianapolis, IN; Furqan Shaikh, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; and Farzana Pashankar, Yale Cancer Center, New Haven, CT
| | - Thomas Olson
- A. Lindsay Frazier and Carlos Rodriguez-Galindo, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA; Juliet P. Hale, Newcastle upon Tyne Hospitals National Health Service (NHS) Foundation Trust, Newcastle upon Tyne; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals NHS Foundation Trust; Matthew J. Murray, University of Cambridge, Cambridge; Claire Thornton, Royal Victoria Hospital, Belfast Health Trust, Belfast; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birgmingham; Sara Stoneham, Children's and Young Persons Cancer Services, University College London Hospital Trusts, London, United Kingdom; Ha Dang, Children's Oncology Group; Mark Krailo, University of Southern California, Los Angeles, CA; Thomas Olson, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center Dallas, Dallas, TX; Deborah Billmire, Riley Hospital for Children, Indianapolis, IN; Furqan Shaikh, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; and Farzana Pashankar, Yale Cancer Center, New Haven, CT
| | - Matthew J Murray
- A. Lindsay Frazier and Carlos Rodriguez-Galindo, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA; Juliet P. Hale, Newcastle upon Tyne Hospitals National Health Service (NHS) Foundation Trust, Newcastle upon Tyne; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals NHS Foundation Trust; Matthew J. Murray, University of Cambridge, Cambridge; Claire Thornton, Royal Victoria Hospital, Belfast Health Trust, Belfast; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birgmingham; Sara Stoneham, Children's and Young Persons Cancer Services, University College London Hospital Trusts, London, United Kingdom; Ha Dang, Children's Oncology Group; Mark Krailo, University of Southern California, Los Angeles, CA; Thomas Olson, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center Dallas, Dallas, TX; Deborah Billmire, Riley Hospital for Children, Indianapolis, IN; Furqan Shaikh, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; and Farzana Pashankar, Yale Cancer Center, New Haven, CT
| | - James F Amatruda
- A. Lindsay Frazier and Carlos Rodriguez-Galindo, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA; Juliet P. Hale, Newcastle upon Tyne Hospitals National Health Service (NHS) Foundation Trust, Newcastle upon Tyne; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals NHS Foundation Trust; Matthew J. Murray, University of Cambridge, Cambridge; Claire Thornton, Royal Victoria Hospital, Belfast Health Trust, Belfast; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birgmingham; Sara Stoneham, Children's and Young Persons Cancer Services, University College London Hospital Trusts, London, United Kingdom; Ha Dang, Children's Oncology Group; Mark Krailo, University of Southern California, Los Angeles, CA; Thomas Olson, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center Dallas, Dallas, TX; Deborah Billmire, Riley Hospital for Children, Indianapolis, IN; Furqan Shaikh, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; and Farzana Pashankar, Yale Cancer Center, New Haven, CT
| | - Claire Thornton
- A. Lindsay Frazier and Carlos Rodriguez-Galindo, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA; Juliet P. Hale, Newcastle upon Tyne Hospitals National Health Service (NHS) Foundation Trust, Newcastle upon Tyne; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals NHS Foundation Trust; Matthew J. Murray, University of Cambridge, Cambridge; Claire Thornton, Royal Victoria Hospital, Belfast Health Trust, Belfast; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birgmingham; Sara Stoneham, Children's and Young Persons Cancer Services, University College London Hospital Trusts, London, United Kingdom; Ha Dang, Children's Oncology Group; Mark Krailo, University of Southern California, Los Angeles, CA; Thomas Olson, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center Dallas, Dallas, TX; Deborah Billmire, Riley Hospital for Children, Indianapolis, IN; Furqan Shaikh, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; and Farzana Pashankar, Yale Cancer Center, New Haven, CT
| | - G Suren Arul
- A. Lindsay Frazier and Carlos Rodriguez-Galindo, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA; Juliet P. Hale, Newcastle upon Tyne Hospitals National Health Service (NHS) Foundation Trust, Newcastle upon Tyne; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals NHS Foundation Trust; Matthew J. Murray, University of Cambridge, Cambridge; Claire Thornton, Royal Victoria Hospital, Belfast Health Trust, Belfast; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birgmingham; Sara Stoneham, Children's and Young Persons Cancer Services, University College London Hospital Trusts, London, United Kingdom; Ha Dang, Children's Oncology Group; Mark Krailo, University of Southern California, Los Angeles, CA; Thomas Olson, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center Dallas, Dallas, TX; Deborah Billmire, Riley Hospital for Children, Indianapolis, IN; Furqan Shaikh, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; and Farzana Pashankar, Yale Cancer Center, New Haven, CT
| | - Deborah Billmire
- A. Lindsay Frazier and Carlos Rodriguez-Galindo, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA; Juliet P. Hale, Newcastle upon Tyne Hospitals National Health Service (NHS) Foundation Trust, Newcastle upon Tyne; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals NHS Foundation Trust; Matthew J. Murray, University of Cambridge, Cambridge; Claire Thornton, Royal Victoria Hospital, Belfast Health Trust, Belfast; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birgmingham; Sara Stoneham, Children's and Young Persons Cancer Services, University College London Hospital Trusts, London, United Kingdom; Ha Dang, Children's Oncology Group; Mark Krailo, University of Southern California, Los Angeles, CA; Thomas Olson, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center Dallas, Dallas, TX; Deborah Billmire, Riley Hospital for Children, Indianapolis, IN; Furqan Shaikh, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; and Farzana Pashankar, Yale Cancer Center, New Haven, CT
| | - Furqan Shaikh
- A. Lindsay Frazier and Carlos Rodriguez-Galindo, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA; Juliet P. Hale, Newcastle upon Tyne Hospitals National Health Service (NHS) Foundation Trust, Newcastle upon Tyne; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals NHS Foundation Trust; Matthew J. Murray, University of Cambridge, Cambridge; Claire Thornton, Royal Victoria Hospital, Belfast Health Trust, Belfast; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birgmingham; Sara Stoneham, Children's and Young Persons Cancer Services, University College London Hospital Trusts, London, United Kingdom; Ha Dang, Children's Oncology Group; Mark Krailo, University of Southern California, Los Angeles, CA; Thomas Olson, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center Dallas, Dallas, TX; Deborah Billmire, Riley Hospital for Children, Indianapolis, IN; Furqan Shaikh, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; and Farzana Pashankar, Yale Cancer Center, New Haven, CT
| | - Farzana Pashankar
- A. Lindsay Frazier and Carlos Rodriguez-Galindo, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA; Juliet P. Hale, Newcastle upon Tyne Hospitals National Health Service (NHS) Foundation Trust, Newcastle upon Tyne; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals NHS Foundation Trust; Matthew J. Murray, University of Cambridge, Cambridge; Claire Thornton, Royal Victoria Hospital, Belfast Health Trust, Belfast; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birgmingham; Sara Stoneham, Children's and Young Persons Cancer Services, University College London Hospital Trusts, London, United Kingdom; Ha Dang, Children's Oncology Group; Mark Krailo, University of Southern California, Los Angeles, CA; Thomas Olson, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center Dallas, Dallas, TX; Deborah Billmire, Riley Hospital for Children, Indianapolis, IN; Furqan Shaikh, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; and Farzana Pashankar, Yale Cancer Center, New Haven, CT
| | - Sara Stoneham
- A. Lindsay Frazier and Carlos Rodriguez-Galindo, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA; Juliet P. Hale, Newcastle upon Tyne Hospitals National Health Service (NHS) Foundation Trust, Newcastle upon Tyne; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals NHS Foundation Trust; Matthew J. Murray, University of Cambridge, Cambridge; Claire Thornton, Royal Victoria Hospital, Belfast Health Trust, Belfast; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birgmingham; Sara Stoneham, Children's and Young Persons Cancer Services, University College London Hospital Trusts, London, United Kingdom; Ha Dang, Children's Oncology Group; Mark Krailo, University of Southern California, Los Angeles, CA; Thomas Olson, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center Dallas, Dallas, TX; Deborah Billmire, Riley Hospital for Children, Indianapolis, IN; Furqan Shaikh, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; and Farzana Pashankar, Yale Cancer Center, New Haven, CT
| | - Mark Krailo
- A. Lindsay Frazier and Carlos Rodriguez-Galindo, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA; Juliet P. Hale, Newcastle upon Tyne Hospitals National Health Service (NHS) Foundation Trust, Newcastle upon Tyne; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals NHS Foundation Trust; Matthew J. Murray, University of Cambridge, Cambridge; Claire Thornton, Royal Victoria Hospital, Belfast Health Trust, Belfast; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birgmingham; Sara Stoneham, Children's and Young Persons Cancer Services, University College London Hospital Trusts, London, United Kingdom; Ha Dang, Children's Oncology Group; Mark Krailo, University of Southern California, Los Angeles, CA; Thomas Olson, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center Dallas, Dallas, TX; Deborah Billmire, Riley Hospital for Children, Indianapolis, IN; Furqan Shaikh, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; and Farzana Pashankar, Yale Cancer Center, New Haven, CT
| | - James C Nicholson
- A. Lindsay Frazier and Carlos Rodriguez-Galindo, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA; Juliet P. Hale, Newcastle upon Tyne Hospitals National Health Service (NHS) Foundation Trust, Newcastle upon Tyne; Matthew J. Murray and James C. Nicholson, Cambridge University Hospitals NHS Foundation Trust; Matthew J. Murray, University of Cambridge, Cambridge; Claire Thornton, Royal Victoria Hospital, Belfast Health Trust, Belfast; G. Suren Arul, Birmingham Children's Hospital NHS Foundation Trust, Birgmingham; Sara Stoneham, Children's and Young Persons Cancer Services, University College London Hospital Trusts, London, United Kingdom; Ha Dang, Children's Oncology Group; Mark Krailo, University of Southern California, Los Angeles, CA; Thomas Olson, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James F. Amatruda, University of Texas Southwestern Medical Center and Children's Medical Center Dallas, Dallas, TX; Deborah Billmire, Riley Hospital for Children, Indianapolis, IN; Furqan Shaikh, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; and Farzana Pashankar, Yale Cancer Center, New Haven, CT
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