PEDIATRIC ONCOLOGY GROUP PROGRAM

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With the almost explosive evolution of new data on the nature of tumor biology, the mandate for cooperative groups in the forseeable future becomes increasingly more challenging and complex. Information on tumor biology must be incorporated into the development of feasible group-will and intra(sub) group phase II/III studies. As a result, protocols designed for specific subgroups in acute lymphoblastic leukemia must address T-cell and B-cell subtypes and continue to delve into the nature of pre-B and pre-T subtypes. In AML, efforts must be made to identify risk factors whilst utilizing randomized trials of best available "standard" therapy. In this regard, efforts must be made to evaluate new combinations of proven therapy utilizing new knowledge of (1) drug-drug interaction, (2) efficacy of high or mega-dose therapy, and (3) the role of "cleansing" techniques. Examples of (1) include methotrexate-asparaginase, (2) high dose cytosine arabinoside, and (3) antibody purging. Bone marrow transplantation as a major therapeutic arm deserves intensive evaluation. The University of Florida has developed a most favorable preparative regimen for second remission ALL, as part of an 8 institution POG study which, which it will now apply to first remission high risk ALL. A proposal for marrow transplantation in second remission AML is now available for group use, and bone marrow transplantation is underway in high risk neuroblastoma, and is being piloted locally in Hodgkin's disease, Ewing's sarcoma and non-Hodgkin's lymphoma. Bone marrow cleansing with antibody coated magnetized microspheres directed against neuroblastoma, cALLa(+), ALL and T-cell ALL are underway locally. The University of Florida Bone Marrow Transplantation Unit is also a component of a multi-institution CML transplantation study. In addition to active participation in whole group efforts, ongoing programs in pharmacology and pharmacokinetics will continue in order to design regimens which will address the propitious use of chemotherapeutic agents. Finally, this division has expanded its program to include University Hospital of Jacksonville, has submitted additional institutions for cancer control and has broadened its range of studies in genetics and long term effects.