5
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von Hoff K, Haberler C, Schmitt-Hoffner F, Schepke E, de Rojas T, Jacobs S, Zapotocky M, Sumerauer D, Perek-Polnik M, Dufour C, van Vuurden D, Slavc I, Gojo J, Pickles JC, Gerber NU, Massimino M, Gil-da-Costa MJ, Garami M, Kumirova E, Sehested A, Scheie D, Cruz O, Moreno L, Cho J, Zeller B, Bovenschen N, Grotzer M, Alderete D, Snuderl M, Zheludkova O, Golanov A, Okonechnikov K, Mynarek M, Juhnke BO, Rutkowski S, Schüller U, Pizer B, Zezschwitz BV, Kwiecien R, Wechsung M, Konietschke F, Hwang EI, Sturm D, Pfister SM, von Deimling A, Rushing EJ, Ryzhova M, Hauser P, Łastowska M, Wesseling P, Giangaspero F, Hawkins C, Figarella-Branger D, Eberhart C, Burger P, Gessi M, Korshunov A, Jacques TS, Capper D, Pietsch T, Kool M. Therapeutic implications of improved molecular diagnostics for rare CNS-embryonal tumor entities: results of an international, retrospective study. Neuro Oncol 2021; 23:1597-1611. [PMID: 34077956 DOI: 10.1093/neuonc/noab136] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Only few data are available on treatment-associated behavior of distinct rare CNS-embryonal tumor entities previously treated as "CNS-primitive neuroectodermal tumors" (CNS-PNET). Respective data on specific entities, including CNS neuroblastoma, FOXR2 activated (CNS NB-FOXR2), and embryonal tumor with multi-layered rosettes (ETMR) are needed for development of differentiated treatment strategies. METHODS Within this retrospective, international study, tumor samples of clinically well-annotated patients with the original diagnosis of CNS-PNET were analyzed using DNA methylation arrays (n=307). Additional cases (n=66) with DNA methylation pattern of CNS NB-FOXR2 were included irrespective of initial histological diagnosis. Pooled clinical data (n=292) were descriptively analyzed. RESULTS DNA methylation profiling of "CNS-PNET" classified 58(19%) cases as ETMR, 57(19%) as HGG, 36(12%) as CNS NB-FOXR2, and 89(29%) cases were classified into 18 other entities. Sixty-seven (22%) cases did not show DNA methylation patterns similar to established CNS tumor reference classes. Best treatment results were achieved for CNS NB-FOXR2 patients (5-year PFS: 63%±7%, OS: 85%±5%, n=63), with 35/42 progression-free survivors after upfront craniospinal irradiation (CSI) and chemotherapy. The worst outcome was seen for ETMR and HGG patients with 5-year PFS of 18%±6% and 22%±7%, and 5-year OS of 24%±6% and 25%±7%, respectively. CONCLUSION The historically reported poor outcome of CNS-PNET patients becomes highly variable when tumors are molecularly classified based on DNA methylation profiling. Patients with CNS NB-FOXR2 responded well to current treatments and a standard-risk-CSI based regimen may be prospectively evaluated. The poor outcome of ETMR across applied treatment strategies substantiates the necessity for evaluation of novel treatments.
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Affiliation(s)
- Katja von Hoff
- Department of Pediatric Oncology and Hematology, Charité University Medicine, Berlin, Germany
| | - Christine Haberler
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Austria
| | - Felix Schmitt-Hoffner
- Hopp Children´s Cancer Center (KiTZ), Heidelberg, Germany.,Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany.,Faculty of Biosciences, Heidelberg University, Heidelberg, Germany
| | - Elizabeth Schepke
- The Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Teresa de Rojas
- Pediatric OncoGenomics Unit, Children's University Hospital Niño Jesús, Madrid, Spain
| | - Sandra Jacobs
- Department of Pediatrics, KU Leuven and University Hospitals Leuven, Leuven, Belgium
| | - Michal Zapotocky
- Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - David Sumerauer
- Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Marta Perek-Polnik
- Department of Oncology, The Children's Memorial Health Institute, University of Warsaw, Warsaw, Poland
| | - Christelle Dufour
- Gustave Roussy Cancer Center, Department of Pediatric and Adolescent Oncology, Villejuif, France.,Paris-Saclay University, INSERM, Molecular predictors and New targets in Oncology, Villejuif, France
| | | | - Irene Slavc
- Department of Pediatrics and Adolescent Medicine and Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Johannes Gojo
- Department of Pediatrics and Adolescent Medicine and Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Jessica C Pickles
- Developmental Biology and Cancer Research & Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK.,Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Nicolas U Gerber
- Department of Oncology, University Children's Hospital, Zurich, Switzerland
| | - Maura Massimino
- Pediatric Unit, Fondazione IRCCS Istituto Nazionale die Tumori, Milan, Italy
| | | | - Miklos Garami
- 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Ella Kumirova
- Department of Neuro-Oncology, Dmitry Rogachev National Medical Research Center for Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Astrid Sehested
- Department of Pediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark
| | - David Scheie
- Department of Pathology, Rigshospitalet, Copenhagen University Hospital, Frederik Vs vej 11, 2100 Copenhagen, Denmark
| | - Ofelia Cruz
- Pediatric Oncology Department. Hospital Sant Joan de Deu. Barcelona, Spain
| | - Lucas Moreno
- Paediatric Haematology & Oncology Division, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Jaeho Cho
- Dept. of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Bernward Zeller
- Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Niels Bovenschen
- Department of Pathology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Michael Grotzer
- Department of Oncology, University Children's Hospital, Zurich, Switzerland
| | - Daniel Alderete
- Service of Hematology/Oncology, Hospital JP Garrahan, Buenos Aires, Argentina
| | - Matija Snuderl
- Department of Pathology, NYU Langone Health and School of Medicine, New York, NY, USA
| | - Olga Zheludkova
- Department of Neurooncology, Russian Scientific Center of Radiology, Moscow, Russia
| | - Andrey Golanov
- Department of Neuroradiology, Burdenko Neurosurgical Institute, Moscow, Russia
| | - Konstantin Okonechnikov
- Hopp Children´s Cancer Center (KiTZ), Heidelberg, Germany.,Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Martin Mynarek
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg
| | - B Ole Juhnke
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg
| | - Stefan Rutkowski
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg
| | - Ulrich Schüller
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg.,Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Research Institute Children's Cancer Center Hamburg, Hamburg, Germany
| | - Barry Pizer
- Institute of Translational Research, University of Liverpool, UK
| | - Barbara V Zezschwitz
- Department of Pediatric Oncology and Hematology, Charité University Medicine, Berlin, Germany
| | - Robert Kwiecien
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - Maximilian Wechsung
- Institute of Biometry and Clinical Epidemiology, Charité University Medicine and Berlin Institute of Health, Berlin, Germany
| | - Frank Konietschke
- Institute of Biometry and Clinical Epidemiology, Charité University Medicine and Berlin Institute of Health, Berlin, Germany
| | - Eugene I Hwang
- Department of Pediatric Hematology-Oncology, Center for Cancer and Immunology Research and Neuroscience Research, Children's National Medical Center, Washington DC, USA
| | - Dominik Sturm
- Hopp Children´s Cancer Center (KiTZ), Heidelberg, Germany.,Pediatric Glioma Research, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany.,Department of Pediatric Oncology, Hematology & Immunology, Heidelberg University Hospital, Heidelberg, Germany
| | - Stefan M Pfister
- Hopp Children´s Cancer Center (KiTZ), Heidelberg, Germany.,Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany.,Department of Pediatric Oncology, Hematology & Immunology, Heidelberg University Hospital, Heidelberg, Germany
| | - Andreas von Deimling
- Department of Neuropathology, Heidelberg University Hospital, Heidelberg, Germany.,Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Elisabeth J Rushing
- Institute of Neuropathology, University Medical Center Zurich, Zurich, Switzerland
| | - Marina Ryzhova
- Department of Neuropathology, Burdenko Neurosurgical Institute, Moscow, Russia
| | - Peter Hauser
- 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Maria Łastowska
- Department of Pathomorphology, Children's Memorial Health Institute, Warsaw, Poland
| | - Pieter Wesseling
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,Amsterdam University Medical Center / VUmc, Amsterdam, The Netherlands
| | - Felice Giangaspero
- Department of Radiological, Oncological and Anatomopathological Sciences, Sapienza University of Rome, Rome, Italy.,IRCCS Neuromed, Pozzilli (IS), Italy
| | - Cynthia Hawkins
- Division of Pathology, The Hospital for Sick Children, Toronto, Canada
| | - Dominique Figarella-Branger
- Aix-Marseille Univ, APHM, CNRS, INP, Inst Neurophysiopathol, CHU Timone, Service d'Anatomie Pathologique et de Neuropathologie, Marseille, France
| | - Charles Eberhart
- Department of Pathology, Johns Hopkins University, Baltimore, MD, USA
| | - Peter Burger
- Department of Pathology, Johns Hopkins University, Baltimore, MD, USA
| | - Marco Gessi
- Neuropathology Unit, Division of Pathology, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Università Cattolica S.Cuore, Rome, Italy
| | - Andrey Korshunov
- Department of Neuropathology, Heidelberg University Hospital, Heidelberg, Germany.,Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Tom S Jacques
- Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - David Capper
- Department of Neuropathology, Charité University Medicine, and Berlin Institute of Health, Berlin, Germany.,German Cancer Consortium (DKTK), partner site Berlin, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Torsten Pietsch
- Department of Neuropathology, DGNN Brain Tumor Reference Center, University of Bonn, DZNE German Center for Neurodegenerative Diseases, Bonn, Germany
| | - Marcel Kool
- Hopp Children´s Cancer Center (KiTZ), Heidelberg, Germany.,Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany.,Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
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15
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Hwang EI, Kool M, Burger PC, Capper D, Chavez L, Brabetz S, Williams-Hughes C, Billups C, Heier L, Jaju A, Michalski J, Li Y, Leary S, Zhou T, von Deimling A, Jones DT, Fouladi M, Pollack IF, Gajjar A, Packer RJ, Pfister SM, Olson JM. Extensive Molecular and Clinical Heterogeneity in Patients With Histologically Diagnosed CNS-PNET Treated as a Single Entity: A Report From the Children's Oncology Group Randomized ACNS0332 Trial. J Clin Oncol 2018; 36:JCO2017764720. [PMID: 30332335 PMCID: PMC9153369 DOI: 10.1200/jco.2017.76.4720] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2023] Open
Abstract
PURPOSE Children with histologically diagnosed high-risk medulloblastoma, supratentorial primitive neuroectodermal tumor of the CNS (CNS-PNET), and pineoblastoma (PBL) have had poor survival despite intensive treatment. We included these patients in this Children's Oncology Group trial. Molecular profiling later revealed tumor heterogeneity that was not detectable at protocol inception. Enrollment of patients with CNS-PNET/PBL was subsequently discontinued, and outcomes for this part of the study are reported here. PATIENTS AND METHODS In this phase III, four-arm prospective trial, consenting children age 3-22 years with newly diagnosed CNS-PNET were randomly assigned (1:1) to receive carboplatin during radiation and/or adjuvant isotretinoin after standard intensive therapy. Primary outcome measure was event-free survival (EFS) in the intent-to-treat population. Molecular tumor classification was retrospectively completed using DNA methylation profiling. RESULTS Eighty-five participants with institutionally diagnosed CNS-PNETs/PBLs were enrolled. Of 60 patients with sufficient tissue, 31 were nonpineal in location, of which 22 (71%) represented tumors that were not intended for trial inclusion, including 18 high-grade gliomas (HGGs), two atypical teratoid rhabdoid tumors, and two ependymomas. Outcomes across tumor types were strikingly different. Patients with supratentorial embryonal tumors/PBLs exhibited 5-year EFS and overall survival of 62.8% (95% CI, 43.4% to 82.2%) and 78.5% (95% CI, 62.2% to 94.8%), respectively, whereas patients with molecularly classified HGG had EFS and overall survival of 5.6% (95% CI, 0% to 13.0%) and 12.0% (95% CI, 0% to 24.7%), respectively. Neither carboplatin, nor isotretinoin significantly altered outcomes for all patients. Survival for patients with HGG was similar to that of historic studies that avoid craniospinal irradiation and intensive chemotherapy. CONCLUSION For patients with CNS-PNET/PBL, prognosis is considerably better than previously assumed when molecularly confirmed HGGs are removed. Identification of molecular HGGs may spare affected children from unhelpful intensive treatment. This trial highlights the challenges of a histology-based diagnosis for pediatric brain tumors and indicates that molecular profiling should become a standard component of initial diagnosis.
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Affiliation(s)
- Eugene I. Hwang
- Eugene I. Hwang and Roger J. Packer, Children’s National Medical Center, Washington, DC; Marcel Kool, Lukas Chavez, Sebastian Brabetz, David T.W. Jones, and Stefan M. Pfister, German Cancer Research Center; David Capper, Andreas von Deimling, and Stefan M. Pfister, University Hospital Heidelberg; Stefan M. Pfister, National Center for Tumor Diseases, Heidelberg; David Capper, Charité Medical University, Berlin, Germany; Peter C. Burger, Johns Hopkins University, Baltimore, MD; Chris Williams-Hughes, Children’s Oncology Group, Littleton, CO; Catherine Billups, Yimei Li, and Amar Gajjar, St Jude Children’s Research Hospital, Memphis, TN; Linda Heier, Weill Cornell Medical College, New York, NY; Alok Jaju, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL; Jeff Michalski, Washington University School of Medicine, St. Louis, MO; Sarah Leary and James M. Olson, Seattle Children’s Hospital and Research Institute; Sarah Leary and James M. Olson, Fred Hutchinson Cancer Research Center, Seattle, WA; Tianni Zhou, California State University, Long Beach, Long Beach, CA; Maryam Fouladi, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; and Ian F. Pollack, Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA
| | - Marcel Kool
- Eugene I. Hwang and Roger J. Packer, Children’s National Medical Center, Washington, DC; Marcel Kool, Lukas Chavez, Sebastian Brabetz, David T.W. Jones, and Stefan M. Pfister, German Cancer Research Center; David Capper, Andreas von Deimling, and Stefan M. Pfister, University Hospital Heidelberg; Stefan M. Pfister, National Center for Tumor Diseases, Heidelberg; David Capper, Charité Medical University, Berlin, Germany; Peter C. Burger, Johns Hopkins University, Baltimore, MD; Chris Williams-Hughes, Children’s Oncology Group, Littleton, CO; Catherine Billups, Yimei Li, and Amar Gajjar, St Jude Children’s Research Hospital, Memphis, TN; Linda Heier, Weill Cornell Medical College, New York, NY; Alok Jaju, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL; Jeff Michalski, Washington University School of Medicine, St. Louis, MO; Sarah Leary and James M. Olson, Seattle Children’s Hospital and Research Institute; Sarah Leary and James M. Olson, Fred Hutchinson Cancer Research Center, Seattle, WA; Tianni Zhou, California State University, Long Beach, Long Beach, CA; Maryam Fouladi, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; and Ian F. Pollack, Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA
| | - Peter C. Burger
- Eugene I. Hwang and Roger J. Packer, Children’s National Medical Center, Washington, DC; Marcel Kool, Lukas Chavez, Sebastian Brabetz, David T.W. Jones, and Stefan M. Pfister, German Cancer Research Center; David Capper, Andreas von Deimling, and Stefan M. Pfister, University Hospital Heidelberg; Stefan M. Pfister, National Center for Tumor Diseases, Heidelberg; David Capper, Charité Medical University, Berlin, Germany; Peter C. Burger, Johns Hopkins University, Baltimore, MD; Chris Williams-Hughes, Children’s Oncology Group, Littleton, CO; Catherine Billups, Yimei Li, and Amar Gajjar, St Jude Children’s Research Hospital, Memphis, TN; Linda Heier, Weill Cornell Medical College, New York, NY; Alok Jaju, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL; Jeff Michalski, Washington University School of Medicine, St. Louis, MO; Sarah Leary and James M. Olson, Seattle Children’s Hospital and Research Institute; Sarah Leary and James M. Olson, Fred Hutchinson Cancer Research Center, Seattle, WA; Tianni Zhou, California State University, Long Beach, Long Beach, CA; Maryam Fouladi, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; and Ian F. Pollack, Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA
| | - David Capper
- Eugene I. Hwang and Roger J. Packer, Children’s National Medical Center, Washington, DC; Marcel Kool, Lukas Chavez, Sebastian Brabetz, David T.W. Jones, and Stefan M. Pfister, German Cancer Research Center; David Capper, Andreas von Deimling, and Stefan M. Pfister, University Hospital Heidelberg; Stefan M. Pfister, National Center for Tumor Diseases, Heidelberg; David Capper, Charité Medical University, Berlin, Germany; Peter C. Burger, Johns Hopkins University, Baltimore, MD; Chris Williams-Hughes, Children’s Oncology Group, Littleton, CO; Catherine Billups, Yimei Li, and Amar Gajjar, St Jude Children’s Research Hospital, Memphis, TN; Linda Heier, Weill Cornell Medical College, New York, NY; Alok Jaju, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL; Jeff Michalski, Washington University School of Medicine, St. Louis, MO; Sarah Leary and James M. Olson, Seattle Children’s Hospital and Research Institute; Sarah Leary and James M. Olson, Fred Hutchinson Cancer Research Center, Seattle, WA; Tianni Zhou, California State University, Long Beach, Long Beach, CA; Maryam Fouladi, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; and Ian F. Pollack, Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA
| | - Lukas Chavez
- Eugene I. Hwang and Roger J. Packer, Children’s National Medical Center, Washington, DC; Marcel Kool, Lukas Chavez, Sebastian Brabetz, David T.W. Jones, and Stefan M. Pfister, German Cancer Research Center; David Capper, Andreas von Deimling, and Stefan M. Pfister, University Hospital Heidelberg; Stefan M. Pfister, National Center for Tumor Diseases, Heidelberg; David Capper, Charité Medical University, Berlin, Germany; Peter C. Burger, Johns Hopkins University, Baltimore, MD; Chris Williams-Hughes, Children’s Oncology Group, Littleton, CO; Catherine Billups, Yimei Li, and Amar Gajjar, St Jude Children’s Research Hospital, Memphis, TN; Linda Heier, Weill Cornell Medical College, New York, NY; Alok Jaju, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL; Jeff Michalski, Washington University School of Medicine, St. Louis, MO; Sarah Leary and James M. Olson, Seattle Children’s Hospital and Research Institute; Sarah Leary and James M. Olson, Fred Hutchinson Cancer Research Center, Seattle, WA; Tianni Zhou, California State University, Long Beach, Long Beach, CA; Maryam Fouladi, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; and Ian F. Pollack, Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA
| | - Sebastian Brabetz
- Eugene I. Hwang and Roger J. Packer, Children’s National Medical Center, Washington, DC; Marcel Kool, Lukas Chavez, Sebastian Brabetz, David T.W. Jones, and Stefan M. Pfister, German Cancer Research Center; David Capper, Andreas von Deimling, and Stefan M. Pfister, University Hospital Heidelberg; Stefan M. Pfister, National Center for Tumor Diseases, Heidelberg; David Capper, Charité Medical University, Berlin, Germany; Peter C. Burger, Johns Hopkins University, Baltimore, MD; Chris Williams-Hughes, Children’s Oncology Group, Littleton, CO; Catherine Billups, Yimei Li, and Amar Gajjar, St Jude Children’s Research Hospital, Memphis, TN; Linda Heier, Weill Cornell Medical College, New York, NY; Alok Jaju, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL; Jeff Michalski, Washington University School of Medicine, St. Louis, MO; Sarah Leary and James M. Olson, Seattle Children’s Hospital and Research Institute; Sarah Leary and James M. Olson, Fred Hutchinson Cancer Research Center, Seattle, WA; Tianni Zhou, California State University, Long Beach, Long Beach, CA; Maryam Fouladi, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; and Ian F. Pollack, Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA
| | - Chris Williams-Hughes
- Eugene I. Hwang and Roger J. Packer, Children’s National Medical Center, Washington, DC; Marcel Kool, Lukas Chavez, Sebastian Brabetz, David T.W. Jones, and Stefan M. Pfister, German Cancer Research Center; David Capper, Andreas von Deimling, and Stefan M. Pfister, University Hospital Heidelberg; Stefan M. Pfister, National Center for Tumor Diseases, Heidelberg; David Capper, Charité Medical University, Berlin, Germany; Peter C. Burger, Johns Hopkins University, Baltimore, MD; Chris Williams-Hughes, Children’s Oncology Group, Littleton, CO; Catherine Billups, Yimei Li, and Amar Gajjar, St Jude Children’s Research Hospital, Memphis, TN; Linda Heier, Weill Cornell Medical College, New York, NY; Alok Jaju, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL; Jeff Michalski, Washington University School of Medicine, St. Louis, MO; Sarah Leary and James M. Olson, Seattle Children’s Hospital and Research Institute; Sarah Leary and James M. Olson, Fred Hutchinson Cancer Research Center, Seattle, WA; Tianni Zhou, California State University, Long Beach, Long Beach, CA; Maryam Fouladi, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; and Ian F. Pollack, Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA
| | - Catherine Billups
- Eugene I. Hwang and Roger J. Packer, Children’s National Medical Center, Washington, DC; Marcel Kool, Lukas Chavez, Sebastian Brabetz, David T.W. Jones, and Stefan M. Pfister, German Cancer Research Center; David Capper, Andreas von Deimling, and Stefan M. Pfister, University Hospital Heidelberg; Stefan M. Pfister, National Center for Tumor Diseases, Heidelberg; David Capper, Charité Medical University, Berlin, Germany; Peter C. Burger, Johns Hopkins University, Baltimore, MD; Chris Williams-Hughes, Children’s Oncology Group, Littleton, CO; Catherine Billups, Yimei Li, and Amar Gajjar, St Jude Children’s Research Hospital, Memphis, TN; Linda Heier, Weill Cornell Medical College, New York, NY; Alok Jaju, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL; Jeff Michalski, Washington University School of Medicine, St. Louis, MO; Sarah Leary and James M. Olson, Seattle Children’s Hospital and Research Institute; Sarah Leary and James M. Olson, Fred Hutchinson Cancer Research Center, Seattle, WA; Tianni Zhou, California State University, Long Beach, Long Beach, CA; Maryam Fouladi, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; and Ian F. Pollack, Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA
| | - Linda Heier
- Eugene I. Hwang and Roger J. Packer, Children’s National Medical Center, Washington, DC; Marcel Kool, Lukas Chavez, Sebastian Brabetz, David T.W. Jones, and Stefan M. Pfister, German Cancer Research Center; David Capper, Andreas von Deimling, and Stefan M. Pfister, University Hospital Heidelberg; Stefan M. Pfister, National Center for Tumor Diseases, Heidelberg; David Capper, Charité Medical University, Berlin, Germany; Peter C. Burger, Johns Hopkins University, Baltimore, MD; Chris Williams-Hughes, Children’s Oncology Group, Littleton, CO; Catherine Billups, Yimei Li, and Amar Gajjar, St Jude Children’s Research Hospital, Memphis, TN; Linda Heier, Weill Cornell Medical College, New York, NY; Alok Jaju, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL; Jeff Michalski, Washington University School of Medicine, St. Louis, MO; Sarah Leary and James M. Olson, Seattle Children’s Hospital and Research Institute; Sarah Leary and James M. Olson, Fred Hutchinson Cancer Research Center, Seattle, WA; Tianni Zhou, California State University, Long Beach, Long Beach, CA; Maryam Fouladi, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; and Ian F. Pollack, Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA
| | - Alok Jaju
- Eugene I. Hwang and Roger J. Packer, Children’s National Medical Center, Washington, DC; Marcel Kool, Lukas Chavez, Sebastian Brabetz, David T.W. Jones, and Stefan M. Pfister, German Cancer Research Center; David Capper, Andreas von Deimling, and Stefan M. Pfister, University Hospital Heidelberg; Stefan M. Pfister, National Center for Tumor Diseases, Heidelberg; David Capper, Charité Medical University, Berlin, Germany; Peter C. Burger, Johns Hopkins University, Baltimore, MD; Chris Williams-Hughes, Children’s Oncology Group, Littleton, CO; Catherine Billups, Yimei Li, and Amar Gajjar, St Jude Children’s Research Hospital, Memphis, TN; Linda Heier, Weill Cornell Medical College, New York, NY; Alok Jaju, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL; Jeff Michalski, Washington University School of Medicine, St. Louis, MO; Sarah Leary and James M. Olson, Seattle Children’s Hospital and Research Institute; Sarah Leary and James M. Olson, Fred Hutchinson Cancer Research Center, Seattle, WA; Tianni Zhou, California State University, Long Beach, Long Beach, CA; Maryam Fouladi, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; and Ian F. Pollack, Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA
| | - Jeff Michalski
- Eugene I. Hwang and Roger J. Packer, Children’s National Medical Center, Washington, DC; Marcel Kool, Lukas Chavez, Sebastian Brabetz, David T.W. Jones, and Stefan M. Pfister, German Cancer Research Center; David Capper, Andreas von Deimling, and Stefan M. Pfister, University Hospital Heidelberg; Stefan M. Pfister, National Center for Tumor Diseases, Heidelberg; David Capper, Charité Medical University, Berlin, Germany; Peter C. Burger, Johns Hopkins University, Baltimore, MD; Chris Williams-Hughes, Children’s Oncology Group, Littleton, CO; Catherine Billups, Yimei Li, and Amar Gajjar, St Jude Children’s Research Hospital, Memphis, TN; Linda Heier, Weill Cornell Medical College, New York, NY; Alok Jaju, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL; Jeff Michalski, Washington University School of Medicine, St. Louis, MO; Sarah Leary and James M. Olson, Seattle Children’s Hospital and Research Institute; Sarah Leary and James M. Olson, Fred Hutchinson Cancer Research Center, Seattle, WA; Tianni Zhou, California State University, Long Beach, Long Beach, CA; Maryam Fouladi, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; and Ian F. Pollack, Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA
| | - Yimei Li
- Eugene I. Hwang and Roger J. Packer, Children’s National Medical Center, Washington, DC; Marcel Kool, Lukas Chavez, Sebastian Brabetz, David T.W. Jones, and Stefan M. Pfister, German Cancer Research Center; David Capper, Andreas von Deimling, and Stefan M. Pfister, University Hospital Heidelberg; Stefan M. Pfister, National Center for Tumor Diseases, Heidelberg; David Capper, Charité Medical University, Berlin, Germany; Peter C. Burger, Johns Hopkins University, Baltimore, MD; Chris Williams-Hughes, Children’s Oncology Group, Littleton, CO; Catherine Billups, Yimei Li, and Amar Gajjar, St Jude Children’s Research Hospital, Memphis, TN; Linda Heier, Weill Cornell Medical College, New York, NY; Alok Jaju, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL; Jeff Michalski, Washington University School of Medicine, St. Louis, MO; Sarah Leary and James M. Olson, Seattle Children’s Hospital and Research Institute; Sarah Leary and James M. Olson, Fred Hutchinson Cancer Research Center, Seattle, WA; Tianni Zhou, California State University, Long Beach, Long Beach, CA; Maryam Fouladi, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; and Ian F. Pollack, Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA
| | - Sarah Leary
- Eugene I. Hwang and Roger J. Packer, Children’s National Medical Center, Washington, DC; Marcel Kool, Lukas Chavez, Sebastian Brabetz, David T.W. Jones, and Stefan M. Pfister, German Cancer Research Center; David Capper, Andreas von Deimling, and Stefan M. Pfister, University Hospital Heidelberg; Stefan M. Pfister, National Center for Tumor Diseases, Heidelberg; David Capper, Charité Medical University, Berlin, Germany; Peter C. Burger, Johns Hopkins University, Baltimore, MD; Chris Williams-Hughes, Children’s Oncology Group, Littleton, CO; Catherine Billups, Yimei Li, and Amar Gajjar, St Jude Children’s Research Hospital, Memphis, TN; Linda Heier, Weill Cornell Medical College, New York, NY; Alok Jaju, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL; Jeff Michalski, Washington University School of Medicine, St. Louis, MO; Sarah Leary and James M. Olson, Seattle Children’s Hospital and Research Institute; Sarah Leary and James M. Olson, Fred Hutchinson Cancer Research Center, Seattle, WA; Tianni Zhou, California State University, Long Beach, Long Beach, CA; Maryam Fouladi, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; and Ian F. Pollack, Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA
| | - Tianni Zhou
- Eugene I. Hwang and Roger J. Packer, Children’s National Medical Center, Washington, DC; Marcel Kool, Lukas Chavez, Sebastian Brabetz, David T.W. Jones, and Stefan M. Pfister, German Cancer Research Center; David Capper, Andreas von Deimling, and Stefan M. Pfister, University Hospital Heidelberg; Stefan M. Pfister, National Center for Tumor Diseases, Heidelberg; David Capper, Charité Medical University, Berlin, Germany; Peter C. Burger, Johns Hopkins University, Baltimore, MD; Chris Williams-Hughes, Children’s Oncology Group, Littleton, CO; Catherine Billups, Yimei Li, and Amar Gajjar, St Jude Children’s Research Hospital, Memphis, TN; Linda Heier, Weill Cornell Medical College, New York, NY; Alok Jaju, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL; Jeff Michalski, Washington University School of Medicine, St. Louis, MO; Sarah Leary and James M. Olson, Seattle Children’s Hospital and Research Institute; Sarah Leary and James M. Olson, Fred Hutchinson Cancer Research Center, Seattle, WA; Tianni Zhou, California State University, Long Beach, Long Beach, CA; Maryam Fouladi, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; and Ian F. Pollack, Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA
| | - Andreas von Deimling
- Eugene I. Hwang and Roger J. Packer, Children’s National Medical Center, Washington, DC; Marcel Kool, Lukas Chavez, Sebastian Brabetz, David T.W. Jones, and Stefan M. Pfister, German Cancer Research Center; David Capper, Andreas von Deimling, and Stefan M. Pfister, University Hospital Heidelberg; Stefan M. Pfister, National Center for Tumor Diseases, Heidelberg; David Capper, Charité Medical University, Berlin, Germany; Peter C. Burger, Johns Hopkins University, Baltimore, MD; Chris Williams-Hughes, Children’s Oncology Group, Littleton, CO; Catherine Billups, Yimei Li, and Amar Gajjar, St Jude Children’s Research Hospital, Memphis, TN; Linda Heier, Weill Cornell Medical College, New York, NY; Alok Jaju, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL; Jeff Michalski, Washington University School of Medicine, St. Louis, MO; Sarah Leary and James M. Olson, Seattle Children’s Hospital and Research Institute; Sarah Leary and James M. Olson, Fred Hutchinson Cancer Research Center, Seattle, WA; Tianni Zhou, California State University, Long Beach, Long Beach, CA; Maryam Fouladi, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; and Ian F. Pollack, Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA
| | - David T.W. Jones
- Eugene I. Hwang and Roger J. Packer, Children’s National Medical Center, Washington, DC; Marcel Kool, Lukas Chavez, Sebastian Brabetz, David T.W. Jones, and Stefan M. Pfister, German Cancer Research Center; David Capper, Andreas von Deimling, and Stefan M. Pfister, University Hospital Heidelberg; Stefan M. Pfister, National Center for Tumor Diseases, Heidelberg; David Capper, Charité Medical University, Berlin, Germany; Peter C. Burger, Johns Hopkins University, Baltimore, MD; Chris Williams-Hughes, Children’s Oncology Group, Littleton, CO; Catherine Billups, Yimei Li, and Amar Gajjar, St Jude Children’s Research Hospital, Memphis, TN; Linda Heier, Weill Cornell Medical College, New York, NY; Alok Jaju, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL; Jeff Michalski, Washington University School of Medicine, St. Louis, MO; Sarah Leary and James M. Olson, Seattle Children’s Hospital and Research Institute; Sarah Leary and James M. Olson, Fred Hutchinson Cancer Research Center, Seattle, WA; Tianni Zhou, California State University, Long Beach, Long Beach, CA; Maryam Fouladi, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; and Ian F. Pollack, Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA
| | - Maryam Fouladi
- Eugene I. Hwang and Roger J. Packer, Children’s National Medical Center, Washington, DC; Marcel Kool, Lukas Chavez, Sebastian Brabetz, David T.W. Jones, and Stefan M. Pfister, German Cancer Research Center; David Capper, Andreas von Deimling, and Stefan M. Pfister, University Hospital Heidelberg; Stefan M. Pfister, National Center for Tumor Diseases, Heidelberg; David Capper, Charité Medical University, Berlin, Germany; Peter C. Burger, Johns Hopkins University, Baltimore, MD; Chris Williams-Hughes, Children’s Oncology Group, Littleton, CO; Catherine Billups, Yimei Li, and Amar Gajjar, St Jude Children’s Research Hospital, Memphis, TN; Linda Heier, Weill Cornell Medical College, New York, NY; Alok Jaju, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL; Jeff Michalski, Washington University School of Medicine, St. Louis, MO; Sarah Leary and James M. Olson, Seattle Children’s Hospital and Research Institute; Sarah Leary and James M. Olson, Fred Hutchinson Cancer Research Center, Seattle, WA; Tianni Zhou, California State University, Long Beach, Long Beach, CA; Maryam Fouladi, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; and Ian F. Pollack, Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA
| | - Ian F. Pollack
- Eugene I. Hwang and Roger J. Packer, Children’s National Medical Center, Washington, DC; Marcel Kool, Lukas Chavez, Sebastian Brabetz, David T.W. Jones, and Stefan M. Pfister, German Cancer Research Center; David Capper, Andreas von Deimling, and Stefan M. Pfister, University Hospital Heidelberg; Stefan M. Pfister, National Center for Tumor Diseases, Heidelberg; David Capper, Charité Medical University, Berlin, Germany; Peter C. Burger, Johns Hopkins University, Baltimore, MD; Chris Williams-Hughes, Children’s Oncology Group, Littleton, CO; Catherine Billups, Yimei Li, and Amar Gajjar, St Jude Children’s Research Hospital, Memphis, TN; Linda Heier, Weill Cornell Medical College, New York, NY; Alok Jaju, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL; Jeff Michalski, Washington University School of Medicine, St. Louis, MO; Sarah Leary and James M. Olson, Seattle Children’s Hospital and Research Institute; Sarah Leary and James M. Olson, Fred Hutchinson Cancer Research Center, Seattle, WA; Tianni Zhou, California State University, Long Beach, Long Beach, CA; Maryam Fouladi, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; and Ian F. Pollack, Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA
| | - Amar Gajjar
- Eugene I. Hwang and Roger J. Packer, Children’s National Medical Center, Washington, DC; Marcel Kool, Lukas Chavez, Sebastian Brabetz, David T.W. Jones, and Stefan M. Pfister, German Cancer Research Center; David Capper, Andreas von Deimling, and Stefan M. Pfister, University Hospital Heidelberg; Stefan M. Pfister, National Center for Tumor Diseases, Heidelberg; David Capper, Charité Medical University, Berlin, Germany; Peter C. Burger, Johns Hopkins University, Baltimore, MD; Chris Williams-Hughes, Children’s Oncology Group, Littleton, CO; Catherine Billups, Yimei Li, and Amar Gajjar, St Jude Children’s Research Hospital, Memphis, TN; Linda Heier, Weill Cornell Medical College, New York, NY; Alok Jaju, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL; Jeff Michalski, Washington University School of Medicine, St. Louis, MO; Sarah Leary and James M. Olson, Seattle Children’s Hospital and Research Institute; Sarah Leary and James M. Olson, Fred Hutchinson Cancer Research Center, Seattle, WA; Tianni Zhou, California State University, Long Beach, Long Beach, CA; Maryam Fouladi, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; and Ian F. Pollack, Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA
| | - Roger J. Packer
- Eugene I. Hwang and Roger J. Packer, Children’s National Medical Center, Washington, DC; Marcel Kool, Lukas Chavez, Sebastian Brabetz, David T.W. Jones, and Stefan M. Pfister, German Cancer Research Center; David Capper, Andreas von Deimling, and Stefan M. Pfister, University Hospital Heidelberg; Stefan M. Pfister, National Center for Tumor Diseases, Heidelberg; David Capper, Charité Medical University, Berlin, Germany; Peter C. Burger, Johns Hopkins University, Baltimore, MD; Chris Williams-Hughes, Children’s Oncology Group, Littleton, CO; Catherine Billups, Yimei Li, and Amar Gajjar, St Jude Children’s Research Hospital, Memphis, TN; Linda Heier, Weill Cornell Medical College, New York, NY; Alok Jaju, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL; Jeff Michalski, Washington University School of Medicine, St. Louis, MO; Sarah Leary and James M. Olson, Seattle Children’s Hospital and Research Institute; Sarah Leary and James M. Olson, Fred Hutchinson Cancer Research Center, Seattle, WA; Tianni Zhou, California State University, Long Beach, Long Beach, CA; Maryam Fouladi, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; and Ian F. Pollack, Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA
| | - Stefan M. Pfister
- Eugene I. Hwang and Roger J. Packer, Children’s National Medical Center, Washington, DC; Marcel Kool, Lukas Chavez, Sebastian Brabetz, David T.W. Jones, and Stefan M. Pfister, German Cancer Research Center; David Capper, Andreas von Deimling, and Stefan M. Pfister, University Hospital Heidelberg; Stefan M. Pfister, National Center for Tumor Diseases, Heidelberg; David Capper, Charité Medical University, Berlin, Germany; Peter C. Burger, Johns Hopkins University, Baltimore, MD; Chris Williams-Hughes, Children’s Oncology Group, Littleton, CO; Catherine Billups, Yimei Li, and Amar Gajjar, St Jude Children’s Research Hospital, Memphis, TN; Linda Heier, Weill Cornell Medical College, New York, NY; Alok Jaju, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL; Jeff Michalski, Washington University School of Medicine, St. Louis, MO; Sarah Leary and James M. Olson, Seattle Children’s Hospital and Research Institute; Sarah Leary and James M. Olson, Fred Hutchinson Cancer Research Center, Seattle, WA; Tianni Zhou, California State University, Long Beach, Long Beach, CA; Maryam Fouladi, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; and Ian F. Pollack, Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA
| | - James M. Olson
- Eugene I. Hwang and Roger J. Packer, Children’s National Medical Center, Washington, DC; Marcel Kool, Lukas Chavez, Sebastian Brabetz, David T.W. Jones, and Stefan M. Pfister, German Cancer Research Center; David Capper, Andreas von Deimling, and Stefan M. Pfister, University Hospital Heidelberg; Stefan M. Pfister, National Center for Tumor Diseases, Heidelberg; David Capper, Charité Medical University, Berlin, Germany; Peter C. Burger, Johns Hopkins University, Baltimore, MD; Chris Williams-Hughes, Children’s Oncology Group, Littleton, CO; Catherine Billups, Yimei Li, and Amar Gajjar, St Jude Children’s Research Hospital, Memphis, TN; Linda Heier, Weill Cornell Medical College, New York, NY; Alok Jaju, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL; Jeff Michalski, Washington University School of Medicine, St. Louis, MO; Sarah Leary and James M. Olson, Seattle Children’s Hospital and Research Institute; Sarah Leary and James M. Olson, Fred Hutchinson Cancer Research Center, Seattle, WA; Tianni Zhou, California State University, Long Beach, Long Beach, CA; Maryam Fouladi, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; and Ian F. Pollack, Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA
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