Memorial Sloan-Kettering Cancer Center's Department of Pediatrics pioneered many treatments that are now the standard of care at other institutions throughout the United States.
Following are some of our "firsts" that are milestones in the treatment of childhood cancers.
Innovations in How Treatment and Post-Treatment Care Are Delivered
- Opened the first Pediatric Day Hospital. Its creation changed the therapy children received from predominantly inpatient to predominantly outpatient without compromising the intensity of curative treatment. This innovation had a tremendous impact on the quality of children's lives and those of their families during treatment.
- Created the first comprehensive program for long-term follow-up of children who were cured of cancer. The Long-Term Follow-Up Program is an individualized program designed to meet the health care needs of childhood cancer survivors and is available to children and young adults who have been off treatment for two years or more.
Discovery Benefiting a Wide Range of Patients
- Discovery of G-CSF, a drug that boosts the production of white blood cells, by Dr. Karl Welte of the Department of Pediatrics, Dr. Malcolm Moore, and Dr. Janice Gabrilove. This led to the first demonstration of effective treatment for genetic deficiencies of white blood cells. G-CSF also provided a way to stimulate early regrowth of white blood cells in patients undergoing chemotherapy, which meant that patients would be at risk for infection for shorter periods of time.
Additional Breakthroughs
- First development of effective chemotherapy for desmoplastic tumors.
- First development of brain tumor protocols that avoid radiation.
- First use of radiolabled antibodies (monoclonal antibodies linked to a radiotherapeutic substance) to treat neuroblastoma and certain other solid tumors in children.
- First use of radiolabeled antibodies to treat metastases in the central nervous system.
- First development and clinical trials of many new chemotherapeutic agents. For example, new analogs of methotrexate that overcome drug resistance were developed at Memorial Sloan-Kettering.
- First demonstration of a genetic basis for drug resistance -- the multidrug resistance gene in neuroblastoma.
- Our transplant service has devised novel approaches incorporating autologous stem cell transplants for the treatment of several developmental tumors in childhood, including neuroblastoma, relapsed Wilms' tumors, and certain brain tumors.
Bone Marrow Transplant
- First unrelated bone marrow transplant.
- First use of T-cell depleted transplants.
- First successful half-matched T-cell depleted marrow transplants for leukemia and for genetic immune deficiency. This advance has made a transplant possible for all children with severe combined immune deficiency, and is now a treatment of choice for that disease, for any patient who lacks a matched sibling donor. The approach is now increasingly used for patients with leukemia as well. We are also exploring allogeneic transplant in the treatment of certain solid tumors, combining transplants with other biologicals to selectively eliminate malignant cells from these patients.
- Conducted the first clinical trials demonstrating the effective treatment of cytomegalovirus pneumonia, which was a significant threat to patients undergoing bone marrow transplantation and was fatal in 80 percent of affected individuals. We conducted the first study of the combination of the antiviral drug ganciclovir and immune globulin. This treatment produced a dramatic gain in survival rates.
- First demonstration that adoptive transfer of immune cells (T-cells) could cure Epstein Barr Virus-associated lymphoma, which can develop as a complication of a bone marrow transplant. It was shown at Memorial Sloan-Kettering that infusion of additional immune cells from the donor can effectively and safely treat this complication in the majority of patients.
- The lowest post-transplant relapse rates in the United States.
Read more about Bone Marrow Transplantation.
Brain Tumors
Brain Tumors are the second most common forms of cancer in children. At Memorial Sloan-Kettering, scientists and clinicians have developed advanced surgical techniques and a new sophisticated computer-guided technique called intensity modulated radiotherapy (IMRT). Clinical trials indicate that this new treatment allows safe delivery of much higher doses of radiation to a brain tumor while sparing the normal developing tissues of the child. New drug therapies have also been developed which can bloster the effectiveness of radiotherapy or, in some types of cancer, replace it. Furthermore, new antibodies linked to radioisotopes are being evaluated in the treatment of small metastases affecting the tissues lining the brain and spinal cord.
Read more about Memorial Sloan-Kettering's approach to the treatment of Brain Tumors.
Leukemia
- Pioneered the use of combination chemotherapy to treat leukemia.
- Developed the New York 1 and New York 2 protocols for the treatment of acute lymphoblastic leukemia. This treatment approach has improved the cure rates for high-risk leukemias in children from approximately 50 percent to close to 80 percent.
- Originated studies demonstrating that anthracycline drugs have late cardiac toxicity, but also establishing that there are ways to administer anthracylines to minimize this problem.
Read more about Memorial Sloan-Kettering's expertise in the treatment of Leukemia.
Lymphoma
- Initiated the LSA2-L2 treatment protocol to treat lymphoma. Before the introduction of this protocol by Memorial Sloan-Kettering physician Norma Wollner, 80 percent to 90 percent of children with lymphoma died of their disease. The LSA2-L2 protocol was so successful that it cured 80 percent to 90 percent of patients, and remained the national standard of care for over two decades.
- First demonstration that adoptive transfer of immune cells (T-cells) could cure Epstein Barr Virus-associated lymphoma, which can develop as a complication of a bone marrow transplant. Memorial Sloan-Kettering clinical researchers showed that infusion of additional immune cells from the donor can effectively and safely treat this complication in the majority of patients.
Read more about treatment for Lymphoma at Memorial Sloan-Kettering.
Neuroblastoma
In our research labs, Memorial Sloan-Kettering scientists are developing new ways to evaluate and treat this dreaded cancer of childhood. Molecular analyses now allow better identification of rare forms of this disease that do not require treatment. More importantly, targeted treatments using antibodies and vaccines when combined with improved chemotherapy, have increased the proportion of children with widely metastatic bad-risk forms of this cancer who are surviving from 10 percent to 50 percent.
- Introduced dose-intensive chemotherapy regimens to treat neuroblastoma, which increased the complete remission rates from less than 30 percent to about 80 percent.
- Introduced the 3F8 monoclonal antibody that targets neuroblastoma. This provided optimal imaging to detect disease, and also added a treatment approach to minimal residual disease after induction of complete remission. As a result, long-term survival increased from 10 percent to 55 percent. This antibody-targeted therapy, when combined with surgery, chemotherapy, and radiation therapy, has radically improved long-term prospects for children with neuroblastoma.
Read more about Neuroblastoma, including information about 3F8 Monoclonal Antibody Therapy.
Radiation Therapy
- Introduction of hyperfractionated radiation. This method has markedly reduced the risk of relapse after transplant while reducing toxicity.
- First use of intensity-modulated radiation therapy to treat solid tumors. This method allows higher intensity treatment to the tumor while sparing normal growing tissues.
Sarcoma
Clinical investigations at Memorial Sloan-Kettering developed the first successful drug combinations for osteogenic sarcoma, pioneered the use of limb sparing surgery and have recently developed new and improved molecular genetic approaches for identifying more aggressive tumors and tumors resistant to current chemotherapy. These advances are guiding the development of new drug treatments designed to contain the cancer cell's resistance, and promising new targeted immune therapies to selectively eliminate residual disease without injuring normal tissue.
- Pioneered the development of limb-sparing surgery for bone sarcomas of the arms and legs, not only improving long-term prognosis but maximizing a child's chances for a normal life.
- Pioneered the use of preoperative chemotherapy for sarcomas.
- Initiated the T-10 treatment protocol for osteogenic sarcoma, which increased the cure rate from approximately 20 percent to more than 70 percent.
Read more about Sarcoma treatment at Memorial Sloan-Kettering.
