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Pediatric Oncology Services
Introduction
St. Jude Children's
The hospital has built an exceptional medical staff of physicians and scientists who have received extensive training in clinical care, basic biomedical sciences and clinical research at St. Jude and from many other premiere institutions throughout the world. St. Jude physicians have expertise in the management of all childhood cancers.
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Special Expertise |
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Outstanding Faculty |
Peter Doherty, PhD, of Immunology was awarded the Nobel Prize for Medicine in 1996 for his discovery of how the immune system recognizes virus-infected cells. This discovery has led to a new understanding of organ rejection after transplants, a better comprehension of genetic susceptibility to disease and new approaches for vaccines. Doherty's discoveries have provided insight for St. Jude scientists who are working to improve the success of stem cell transplants from unmatched donors Doherty; Charles Sherr, MD, PhD, co-chair of Genetics and Tumor Cell Biology; and Robert Webster, PhD, of Infectious Diseases are members of the National Academy of Sciences, which advises the federal government on scientific and technical matters. Dr. Doherty has recently been elected to the Institute of Medicine (IOM), a prestigious branch of the National Academy of Sciences. Arthur Nienhuis, MD, of Hematology and former Hospital Director and CEO and current Hospital Director and CEO William Evans, PharmD, are also members of the IOM Richard Webby, PhD, of Infectious Diseases, is director of the World Health Organization's Collaborating Center for Studies on the Ecology of Influenza Viruses in Lower Animals and Birds. Located at St. Jude, it is the world's only laboratory designed to study influenza at the animal-human interface.
Three young faculty members have been designated Pew Scholars over the past several years. Each one, Schulman, Michael Dyer, PhD of Developmental Neurobiology, and Joseph Opferman, PhD, of Biochemistry, joined 15 of the country's most gifted biomedical scientists, the year of their award. Pew Scholars are junior faculty members at medical schools and research institutions who show outstanding promise in the basic and clinical sciences. Schulman is studying how proteins regulating cell division are specifically destroyed by the cell after their job is done. Dyer has made major contributions to understanding the cause of retinoblastoma and developing mouse models for testing novel therapies. Opferman has made groundbreaking discoveries in the processes that control lymphocyte development. Schulman also joined an elite group of 58 of the country's most promising early-career scientists and engineers when she received a Presidential Early Career Award for Scientists and Engineers (PECASE) at a White House ceremony in |
General Information
| Pediatric Hot Line | 888.226.4343 |
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Location: |
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| Facility Description |
St. Jude includes a state-of-the-art
The hospital's Translational Trials Unit conducts outpatient testing on drugs, vaccines and other agents developed at St. Jude. The Chili's |
| Affiliate Clinics |
· St. Jude Midwest Affiliate in |
| Financial Support | A child eligible for treatment on a St. Jude research protocol is accepted for treatment at St. Jude without regard to the family's ability to pay medical fees. The hospital's fundraising organization, ALSAC®, covers all costs of treatment beyond those reimbursed by third-party insurers and total costs when no insurance is available |
| Travel Assistance | After the initial evaluation, if the patient is eligible for a treatment protocol, St. Jude provides travel expenses for the patient and one family member. |
| Lodging |
St. Jude provides housing free of charge for up to four people while the patient is in treatment in |
| Social Support |
The St. Jude Behavioral Medicine division provides psychological and educational support to patients and families. The hospital provides family counseling during treatment and coordinates any necessary referrals to help ensure continuity of care as children and families return to their home communities. Child psychiatrists and child psychologists are available for psychological evaluation, intervention, and counseling to help children experiencing emotional, cognitive, or behavioral problems. The School Program offers patients the opportunity to continue normal educational activities through homebound or hospital bound educational services and provides school re-entry services to ease the transition back to the community school. For social work support, each patient is assigned a primary master's level social worker who plays an integral role in the patient's clinical cancer care. Social work staff completes a thorough psychosocial assessment for each patient. The Child Life program strives to minimize the stress and anxiety associated with a chronic illness and hospitalization. Child Life Specialists work closely with children and teens to provide non-threatening age appropriate explanations and preparations to aid in understanding and clearing up misconceptions. . In keeping with a commitment to the total child, the Chaplain Services program seeks to support the spiritual, religious, and emotional needs of St. Jude patients, families and their care providers. Pediatric Chaplains provide assessment and appropriate spiritual companionship which supports ritual and Sacramental wants, enhances spiritual coping, fosters hope, and assists in the exploration of suffering and meaning. . Patients, families and their care providers may have additional support through the Quality of Life Service, a palliative and end-of-life care consult service designed to support patients and families in the process of making difficult medical decisions, optimize physical and emotional comfort from distressful symptoms, and enhance care coordination and interdisciplinary collaboration throughout the illness trajectory and across the different setting in which the patient receives care. |
| Home Health Care |
Home health care is arranged. |
| Ages Treated |
Patients under 18 years old are treated, but some protocols extend to older patients. |
| Acceptance Criteria | Acceptance for treatment is based solely on a patient's eligibility for an ongoing clinical trial at St. Jude. The hospital welcomes physician referrals of children and adolescents with newly diagnosed, untreated or suspected cancers; HIV infections, or certain hematologic, immunologic or genetic diseases. In most cases, children must be referred before therapy is started elsewhere. However, children with cancer that has relapsed after prior therapy may be eligible for specific treatment protocols. Patients who have received treatment elsewhere may be accepted on an individual case basis when there is a potential for protocol eligibility in ongoing studies, relapse studies, bone marrow transplantation protocols or Phase I-II studies. Patients with genetic disorders, hematologic, immunologic diseases or HIV infection may be accepted anytime in their disease history based on protocol eligibility or potential to contribute to research projects. Treatment protocols are also available for certain hematologic disorders, congenital immunodeficiency syndromes and genetic disorders. |
Clinical and Research Information
| Director | William E. Evans, PharmD |
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| Clinical Director | Joseph Laver, MD, MHA |
| Scientific Director | James Downing, MD |
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Michael Kastan, MD, PhD |
| Cooperative Group Membership |
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| Cooperative Group Activities | St. Jude oncologists are principal investigators on numerous group and institutional studies. |
| Average Number of Oncology Clinical Trials | 130 |
| Pediatric Clinical Trial Coordinator | Amy Doville, director of Central Protocol and Data Monitoring Office 901.595.3701 |
Research Efforts
Current basic and clinical research at St. Jude Children's
The Developmental Neurobiology department has focused on the role of specific genes in the development and function of the nervous system. Scientists in this program are striving to unravel the brain's complexity and to understand the molecular principles behind its organization and function. Researchers in Developmental Neurobiology also study normal development of the retina as well as team with clinicians in testing new treatments for retinoblastoma, a malignant cancer of the retina.
The Chemical Biology and Therapeutics department was established to facilitate the discovery of new bioactive small molecules. Researchers in this area work to discover and develop novel chemical entities that increase understanding of the pathophysiology of or function as therapeutic leads for the treatment of catastrophic pediatric illnesses.
The department of Epidemiology and Cancer Control is building an internationally recognized program for the conduct of etiology (causes and origins of disease), outcomes, and interventional research in childhood cancer and hematologic conditions. The department has significantly increased St. Jude's ability to include preventive medicine in its overall goal to reduce morbidity and mortality from childhood cancer.
The molecular diagnostics lab at St. Jude was set up to enhance the transfer of technology from the research laboratory to the clinic and vice versa. When researchers identify gene alterations that contribute to malignancies, the molecular diagnostics team designs tests to screen patients for those changes. This team discovered that a shift from one chromosome to another is the most common translocation in pediatric acute lymphoblastic leukemia (ALL). The translocation was once thought to be rare, but this discovery predicts an excellent outcome for all patients with this type of ALL.
Pharmacogenomics/Gene Array Studies
St. Jude is a leading center for pharmacogenomics research, a technology for studying how variations in genes control an individual's response to drug therapy. Such studies are identifying genetic variations that contribute to the success or failure of therapy. Gene expression profiles and gene typing chips obtained with DNA arrays provide clinicians and researchers with a genetic snapshot of each patient's potential response to drug therapy before treatment begins. These profiles identify patients likely to benefit from treatment or suffer a toxic reaction. This work has the potential to differentiate among patients with ALL who can be treated with moderate doses of chemotherapy from those who should be treated aggressively. Mary Relling, Pharm.D., chair of the Department of Pharmaceutical Sciences, is leading a major NIH-funded program to identify the major pharmacogenetic determinants of treatment response in children with ALL. She and her colleagues are world leaders in extending these studies to other catastrophic diseases in children.
Molecular Targeted Therapy Studies
St. Jude research includes studies aimed at determining the expression and activity of molecular targets in patient tissues and the evaluation of drugs that target these molecules. Ongoing projects include testing treatment strategies using gene therapy or small molecule therapy for catastrophic diseases; producing candidate therapeutic agents that can be tested in preclinical studies of catastrophic pediatric diseases; identifying growth signals and cell cycle checkpoint functions essential for survival of malignant cells; and defining new targets for drug therapy to modulate cellular responses to drugs currently used as anticancer agents. The Molecular Clinical Trials Core facility at St. Jude assists faculty in the design, conduct and interpretation of molecular assays of drug target expression and activity in clinical trials.
Special Expertise
Stem Cell Transplant
The Stem Cell Transplantation Program at St. Jude is one of the largest pediatric programs in the world, having performed more than 2,000 transplants, including about 180 transplants in the last year. The hospital treats newborns, infants, children, adolescents and young adults who have malignant or nonmalignant life-threatening disorders that are treatable with hematopoietic stem cell/bone marrow transplants using autologous or allogeneic cells. The hospital has a designated 18-bed unit in its Chili's
Brain Tumors
Developing innovative treatments for brain tumors including medulloblastoma, ependymoma, high-grade gliomas, brainstem gliomas and many others has been the focus of the St. Jude brain tumor program. In order to provide comprehensive care to our pediatric brain tumor patients, we use a multidisciplinary team approach. The experienced healthcare specialists in our multidisciplinary team includes neuro-oncologists, neurosurgeons, neuropathologists, neurobiologists, neuro radiologists and radiation oncologists who have dedicated their careers to finding cures and providing treatment for children with brain tumors. Our brain tumor physicians also work closely with support staff in rehabilitation medicine, nursing, pharmacy, behavioral medicine, clinical nutrition, child life, social work and many other specialties. These support personnel have been specifically trained in caring for pediatric brain tumor patients and assisting in meeting their special needs of the brain tumor program. In order to provide in planning for future studies and to assist in increasing knowledge about the biology of brain tumors, the clinicians collaborate with the laboratory- based investigators in the Developmental Neurobiology Department. New studies are being developed in hopes of improving cure rates in pediatric brain tumors while minimizing long-term side effects.
Leukemia
St. Jude has extensive expertise and very experienced team in taking care of children and adolescents with leukemia, and through a series of clinical trials, has pushed the overall 5-year survival rate to 94 percent for acute lymphoblastic leukemia and approximately 70 percent for acute myeloid leukemia without the use of prophylactic central-nervous-system radiation. Current research aims to further improve cure rate and quality of life of the patients by optimizing dosage and scheduling of antileukemic agents based on an individual patient's genetic and pharmacologic characteristics. Late effects
After successful treatment, all St. Jude patients are examined one or more times yearly for 10 years in the After Completion of Therapy (ACT) Clinic. Survivors are screened for any residual disease effects or treatment sequelae, including physical, psychological, and social problems. The ACT Clinic emphasizes educating survivors about the importance of maintaining a healthy lifestyle and remaining alert for possible late effects and secondary cancers. Also, the growing population of childhood cancer survivors enables the clinic to gather unique epidemiologic and treatment follow-up data. These findings have enabled physicians to improve therapeutic protocols at St. Jude and to advance pediatric cancer care in the larger community. Survivors who are alumnus of the ACT Clinic are now eligible to return for risk-based cancer-related consultations as part of the St. Jude Life Study. This study aims to establish a lifetime cohort of childhood cancer survivors treated at St. Jude to facilitate evaluation of long-term health outcomes in aging adults surviving pediatric cancer.
Neuroblastoma
Scientists at St. Jude continue to investigate molecular factors associated with neuroblastoma that lead to cell growth and their potential use as targets for new treatment approaches. Current studies include testing of a humanized anitGD2 monoclonal antibody and the use of a new class of anticancer drugs (mTOR inhibitors) predicted to be highly effective in this disease.
Statistics
Percent of children treated in each age range
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0-4 |
5-9 |
10-14 |
15+ |
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Percent Treated |
21.2% |
20.0% |
20.9% |
37.9% |
Pediatric Oncology Program Fiscal Year 2008
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Number of Inpatient Beds |
Number of Oncologists |
Number of Admissions |
Average Length of Stay (days) |
Number of New Outpatients |
Total Outpatient Visits |
Number of Stem Cell Transplants |
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62 |
43 |
2484 |
5.6 |
1459 |
57,412 |
132 |
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