Faculty Bibliography

The treatment of anaplastic large cell lymphoma (ALCL) has largely relied on anthracycline-based chemotherapy. Targeted lymphoma therapy, using an anti-CD30 antibody, provides an innovative treatment modality for specific lymphomas, particularly ALCL. Brentuximab vedotin (BV; SGN-35) uses a CD30 monoclonal antibody to generate apoptosis of targeted lymphoma cells. We present a pediatric patient with ALCL who experienced second relapse after standard chemotherapy and autologous and allogeneic hematopoietic stem cell transplantation. This patient has been treated with BV as a single agent and has sustained remission for several months. BV offers a targeted treatment for relapsed ALCL, even after multiple relapses.

PURPOSE: National guidelines recommend patients with cancer of reproductive age be informed of their risk for infertility resulting from cancer treatment. Despite existing technologies to preserve fertility, many patients report not receiving timely information about fertility risk, and oncology providers report multiple barriers to discussing or referring patients on this topic. METHODS: Nine cancer centers have been recognized as Fertile Hope Centers of Excellence, a designation awarded to cancer centers with an institutionalized approach to addressing fertility issues. Individual semistructured interviews were conducted with each of these centers to identify strengths of and challenges to their approaches. RESULTS: All institutions had procedures for the provision of topical professional and patient education and for notification of patients. Notification methods varied widely, from use of customized consent forms to highly automated electronic alerts for providers. Referral routines and enactment of institutional policies also differed. Key components of successful programs emerged, including the value of internal champions, affiliation with complementary programs, and resource sharing. CONCLUSION: The programs described provide examples of systems that can be assembled in different types of clinical settings, depending on the availability of resources and infrastructure. As institutions develop programs, metrics to evaluate notification systems, in particular, as well as the supportive program components, should be used so identification of best practices can continue. Widespread adoption of programs that incorporate the baseline elements identified will not only comply with national guidelines but also address patients' reproductive needs and fundamentally affect future quality of life.

Preservation of fertility is important to adolescent and young adult (AYA) survivors of cancer. Many survivors will maintain their reproductive potential after the successful completion of treatment for cancer. However total-body irradiation, radiation to the gonads, and chemotherapy regimens containing high-dose alkylators can place women at risk for acute ovarian failure or premature menopause and men at risk for temporary or permanent azoospermia. The most effective and established means of preserving fertility in this population is embryo cryopreservation in women and sperm cryopreservation in men before the initiation of cancer-directed therapy. Cryopreservation of mature oocytes is also becoming more commonplace as methods of thawing become more sophisticated. The use of in vitro fertilization and intracytoplasmic sperm injection has added to the viability of sperm and oocyte cryopreservation. Cryopreservation and transplantation of gonadal tissue in both males and females remains experimental but continues to be evaluated. Hormonal suppression has not been shown to be effective in males but may have promise in females, although larger scale trials are needed to evaluate this. Providing information about risk of infertility and possible interventions to maintain reproductive potential are critical for the AYA population at the time of diagnosis. Given the competing demands of providing complicated and detailed information about cancer treatment, the evolving information related to fertility preservation, and the ethical issues involved, it may be preferable, where possible, to have a specialized team, rather than the primary oncologist, address these issues with AYA patients.

PURPOSE: Fluoro-2-deoxy-D-glucose positron emission tomography scans are becoming standard of care in the evaluation of Hodgkin disease (HD). The frequency of false positive (FP) PET scans in pediatric HD after completion of therapy has not been well studied. PATIENTS AND METHODS: All PET scan reports on pediatric HD patients at our institution between February 2000 and February 2005 were retrospectively reviewed. Scans were considered positive if the interpretation was most consistent with malignancy. FP results were determined by pathologic evaluation, resolution on scan, or absence of disease progression over at least 1 year without intervention. RESULTS: We reviewed 255 PET scans on 47 patients, including 156 posttherapy scans on 34 patients. Positive predictive value for scans obtained during routine follow-up was 11%, with an FP rate of 16%. Identifiable etiologies of FP scans included: fibrosis, progressive transformation of germinal centers, abdominal wall hernia, appendicitis, thymus and HIV associated lymphadenopathy. CONCLUSIONS: Routine PET scans after completion of therapy in pediatric HD patients have a low positive predictive value and a high FP rate. Prospective studies are needed to reduce the ambiguity of positive results. In the interim, positive PET scans after treatment should be interpreted cautiously and therapeutic decisions should not be made without histologic confirmation.

Native cellular fluorescence (NCF) is being investigated as an intermediate endpoint biomarker for chemoprevention. Oral epithelial cells were cultured under three conditions to identify a spectral pattern for epithelial differentiation: cells maintained in serum-free keratinocyte growth medium were the least differentiated (KGM cells); cells switched to DMEM/F12 plus 10% FCS were intermediate in differentiation (DMEM/F12/FCS cells); DMEM/F12/FCS cells switched to serum-free DMEM/F12 plus 0.8 M NaCl to induce cornified envelopes were the most differentiated (DMEM/F12/NaCl cells). The differentiation status was characterized using immunohistochemistry and electron microscopy. NCF analysis was able to distinguish terminally differentiated epithelial cells (DMEM/F12/NaCl) from those less differentiated cells (KGM, DMEM/F12/FCS) in several emission (lambda ex 340 nm, lambda em 360-660 nm; lambda ex 365 nm, lambda em 400-700 nm; lambda ex 420 nm, lambda em 440-800 nm) and excitation scans (lambda ex 200-360 nm; lambda em 380 nm, lambda ex 240-430 nm; lambda em 450 nm, lambda ex 250-460 nm, lambda em 480 nm; lambda ex 270-500 nm, lambda em 520 nm). The ability to discriminate terminal differentiation in this in vitro model supports the concept of using NCF as an intermediate biomarker to monitor in vivo mucosal differentiation.