The DFCI/ALL Consortium began in 1981 and gradually grew over the next two decades and now includes nine collaborating institutions that collectively accrue newly diagnosed pediatric patients for treatment.
Clinical trials through the Consortium demonstrate outstanding results, with five-year event-free survival rates exceeding 86%, and above 90% for standard risk groups. The overarching goals of the Consortium’s studies are to identify of the optimal treatment to improve cure rates, reduce short- and long-term toxicities of treatment, and enhance our biological understanding of ALL and its impact.
Our program at Columbia University Medical Center/ New York Presbyterian – Morgan Stanley Children’s Hospital is one of the larger programs in the Consortium and leads several innovative embedded research programs including:
THE DIET AND ACUTE LYMPHOBLASTIC LEUKEMIA TREATMENT (DALLT) COHORT STUDY
This multicenter study of 794 patients with ALL is the first prospective study to examine dietary intake in a homogenous population of children with cancer.
Led by Elena Ladas, PhD, initial findings reveal that 27 percent of the children were overweight or obese and up to 79 percent exceeded daily recommended calorie intake. While the majority of these patients were within recommended values for vitamin C and calcium, we found deficiencies in vitamins E and D.
One surprising discovery was the wide range of dietary intakes for zinc and folate, with significant differences between standard-risk and high-risk patients. The importance of folate for the treatment of ALL and the development of therapy-related toxicities in ALL has been well documented. Thus, the finding that most children are either under or exceed the RDA may have clinical applications, relating to the development of infections—a serious complication of treatment. Our findings suggest that children and adolescents who are obese at diagnosis may be considered a high-risk group requiring proactive dietary intervention throughout cancer therapy.
Ongoing work on this study by Elena Ladas, PhD, is supported by a mentored career development award from the American Cancer Society.
NEUROCOGNITIVE FUNCTIONING OF ACUTE LYMPHOBLASTIC LEUKEMIA PATIENTS
This study examines neurocognitive functioning over the course of treatment and survivorship using an innovative computer-based testing program, COG-STATE. Eligible patients are those aged 5 years and older who are being treated on or as per the Dana Farber 11-001 Leukemia treatment protocol.
This multicenter study is led by Stephen Sands, PsyD, in collaboration with Peter Cole, MD from Montefiore Medical Center.
ANTIBIOTIC PROPHYLAXIS FOR REDUCTION OF INDUCTION THERAPY RELATED INFECTIONS
Maria Luisa Sulis, MD, is leading an investigation of how antibiotic prophylaxis may impact rates of bacterial infections during the initial induction course of therapy, a phase marked by a nearly 30% incidence of serious infections.
Impact of Sociodemographic and Socioeconomic Factors on Medication Adherence
In a study led by Justine Kahn, MD, parents and caregivers are surveyed to assess barriers to oral chemotherapy adherence in pediatric patients undergoing treatment for acute lymphoblastic leukemia (ALL).
Non-adherence to prescribed treatment regimens is a challenge prevalent in every field of medicine, including the field of pediatric oncology, where oral chemotherapy plays a crucial role in many cancer treatment regimens.
The long-term goal is to develop and implement appropriate and effective teaching measures for at-risk families in order to mitigate any modifiable risk factors associated with treatment non-adherence.