Background: Pediatric cancer stage at diagnosis is critical for prognosis and research comparisons. The Toronto Pediatric Cancer Stage Guidelines standardize staging across childhood malignancies . We developed a framework for automated staging of pediatric cancers. Methods: A structured staging schema was created. An extraction pipeline was implemented to orchestrate agents. The system ingests multi-disciplinary meeting notes, pathology reports, radiology findings, operative notes, and clinic documentation from the first 3 months after diagnosis. One agent identifies the cancer type and maps it to a Toronto diagnostic category, after which another agent applies the relevant staging logic; and a validation agent examines the stage and its logic against summarized documentations. We tested the tool on 500 pediatric cancer cases from our institutional registry. Cases outside the Toronto schema (e.g. acute myeloid leukemia and nasopharyngeal carcinoma, which have no stage per guidelines) were excluded, yielding 433 evaluable cases. Each case was processed independently in two runs. The outputs were compared to an expert consensus reference stage (ground truth) established by four pediatric oncologists. Results: The automated system matched the reference stage in 91.2% of cases overall. Per-run accuracy (compared to ground truth) was 93.8% for the first run and 88.7% for the second run. The two runs agreed on 89.8% of cases (Cohen’s κ=0.785, p<0.001). Accuracy dropped significantly when the validation agent flagged the stage and requested a recalculation. For stages obtained from the first attempt, accuracy was 97%; while for stages achieved on subsequent attempts, accuracy achieved 77%. Conclusion: We demonstrate the first automated staging system for pediatric cancers using standardized Toronto criteria. The tool showed high accuracy comparable to human experts and excellent consistency between independent runs. We identified a measurable metric (number of calculation attempts) that can flag problematic cases for further human analysis.

Aprepitant for Severe Refractory Pruritus in a Patient with Relapsed Hodgkin’s Lymphoma

Background: Interval compression (IC), defined as 2 week-long cycles of alternating vincristine/doxorubicin/cyclophosphamide and ifosfamide/etoposide, improves survival for localized Ewing sarcoma. The outcomes of patients with metastatic disease treated with IC are uncertain. Methods: We retrospectively reviewed the charts of pediatric patients with metastatic Ewing sarcoma treated with IC at our center between January-2013 and March-2020. We calculated event-free survival and overall survival and used log rank tests for univariate comparisons. Results: We identified 34 patients aged 2.7–17.1 years (median,11.6 years). Twenty-six patients (76%) had pulmonary metastases, and 14 (41%) had extra-pulmonary metastases in the bone (n = 11), lymph nodes (n = 2), and intraspinal tissue (n = 1). All patients received local control therapy: surgery only (n = 7, 21%), radiotherapy only (n = 18, 53%), or both (n = 9, 26%). The estimated 3-year OS and EFS were 62%±9% and 39%±9%, respectively. Patients with pulmonary only metastasis had a 3-year OS of 88%±8% in comparison to those with extra-pulmonary metastasis of 27%±13% (P=0.0074). Survival did not differ according to age group (> vs < 12 years), metastasis site, or primary tumor site, but 3-year event-free survival significantly differed according to local control therapy (surgery only, 83% ± 15%; combined surgery and radiation, 30% ± 18%; radiation only, 15% ± 10%; P = .048). Conclusion: IC yielded similar outcomes for patients with metastatic Ewing sarcoma to that reported in the literature using other regimens. We suggest including this approach to other blocks of therapy

Introduction: T-cell acute lymphoblastic leukemia (T-ALL) accounts for approximately 15% of all newly diagnosed ALL in children and adolescents and is associated with worse outcomes compared to pre-B ALL. We aimed to decrease T-ALL relapses by intensifying our regimen. Methods: Patients with T-ALL were treated using two different regimens; before September 2014, patients were treated per St. Jude Total XV protocol; subsequently, a major change was adopted by adding two intensive blocks: FLAG and Re-Intensification (fludarabine, dexamethasone, cytarabine, etoposide and asparaginase). Cranial radiation was limited to patients with WBC >=100k/µl at diagnosis and/or patients with CNS2/CNS3 status. Results: Between June 2005 and April 2020, a total of 100 patients (76 males) were treated and followed for a median of 70 months (range, 14-181 months). Median age at diagnosis was 9 years (range,0.5-17.8 years). Forty-eight patients were diagnosed after September 2014 and received the augmented regimen; their median follow up was 46 months (range,14-74 months). The 5-yr-EFS estimates for patients who received the augmented regimen vs. standard regimen were 87%±4.9% vs 67%±6.8% (p=0.03); and the 5-yr-OS estimates were 87%±5.1% vs. 71%±6.3% (p=0.06) respectively. Treatment related mortality (TRM) were reported in 2 patients treated using our standard regimen but none for patients who received the augmented regimen. Conclusions: We implemented a novel approach with early intensification added to a backbone of modified St. Jude Total-XV regimen for patients with T-ALL that resulted in improved outcome with no treatment related mortality.