The past five years in POG saw stablization and refinement in pre-existing
studies and entirely new approaches to cancer care. Such endeavors mandate
divisions of labor within groups and institutions in terms of accrual,
scientific input, and institutional features. Aggressive up-front therapy
is the most effective regimen for most malignant processes. Single agent
therapy for resistant disease is eventually fruitless, and genetic
information adapted into the fabric of therapy is becoming increasingly
more vital to the development of effective treatment programs. At the U of
F we have (1) increased basic science endeavors so as to address principles
of therapy, and (2) developed FDA approved marrow purging techniques
utilizing monoclonalantibodies and magnetic microspheres for treating high
risk neuroblastoma, which resulted in a five fold increase in DFS. These
pilot studies are now group-wide projects. These techniques when applied
to treatment of cALLa were found to be wanting and a reapprisal was
obviously mandated. Combination MoAb-microspheres in concert with
chemotherapy purging is the reasonable choice for all such patients in whom
allografting is not feasible. Our successful, unrelated donor marrow
transplant program is available for group-wide use. We have competed the
basic science for an approach designed to distinguish between Graft vs.
Host Disease and Graft vs. Leukemia using MoAb to CD 8. Such studies have
been successfully carried out in adults using anti-CD 8 and C. We have
shown that high risk Ewing's sarcoma can be effectively treated with
megadose therapy and marrow rescue and it, too, is ready for group-wide
use. Our data on osteosarcoma therapy with four drug rotational therapy
are no better than any other best therapy. The next o.s. study will
include megadose therapy with marrow rescue prior to surgery. We have
responded to POG's request to initiate bone marrow transplantation for
brain tumors and lymphomas. We will continue to develop (1) long term
marrow self-renewing culture systems, (2) growth factor studies and (3)
polymerase chain reaction studies (for MRD detection) whilst actively
participating in all POG programs as attested by our increased accural over
the five year span during which time we absorbed by the Jacksonville
(University Hospital/Nemours Clinic) institutions into our program, added a
satellite (Miami Children's Hospital), and an affiliate, University of
South Carolina at Charleston, efforts designed to be certain that no child
with cancer is denied best available medicine at best available
institutions.
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Publications
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