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The Youngest Cancer Patients
by Rachel Williams New parents lose a lot of sleep worrying about their newborn’s adjustments to this world, but some parents have more serious concerns—like coping with the dismay of finding out that their baby has cancer. In fact, about 10% of all cancers to strike children under the age of 15 are diagnosed in infants one year old or younger. Infants get the same types of cancer that tend to develop in older children and adolescents—acute leukemias and tumors of the brain, nervous system, lymphatic system, kidneys, bones, and muscles—but the prognosis, behavior, and treatment of these cancers in infants can be very different. While infants with cancer have a much lower five-year survival rate than older children (33% vs. 75%, respectively), pediatric specialists at The University of Texas M. D. Anderson Cancer Center point out that some types of cancer actually have a better prognosis in infants than in older children. And in every case, treatment options improve with specialized care. “For example, children under one year who have neuroblastoma have a better prognosis than older children and are therefore treated a little differently,” said Joann Ater, M.D., a professor in the Division of Pediatrics who has worked at M. D. Anderson for 15 years treating this most common form of infant cancer. “Stage 4, or metastatic, disease has a much more serious prognosis in a patient who is 18 months or older than it does in an infant. Usually, older children get bone marrow transplants, but the really young ones have a good chance of being cured with surgery and chemotherapy. For some of them, if the tumor is local and not metastatic, it is curable with just surgery.” Surprisingly, though, some neuroblastomas are curable in infants without any treatment at all. Over time, stage 4S neuroblastoma (a special stage, distinct from stage 4) can actually regress or even entirely disappear on its own. Genes may be key A tumor’s unique behavior in infants may have an underlying genetic cause. “Tumors in babies are genetically different in many cases from tumors that occur in older people, even in the same types of cancer,” explained Dr. Ater. Cynthia E. Herzog, M.D., an associate professor in the Division of Pediatrics, explained that there is no specific biomarker that allows researchers to distinguish the type of neuroblastoma that can regress on its own from others, so it is a matter of watchful waiting and careful balancing of treatment decisions. “It is different, but we cannot say exactly how it is different. It can’t be defined biologically or histologically, and we can’t predict which kids have this type of tumor and which do not,” said Dr. Herzog. “The trick is that you don’t want to overtreat kids who have tumors that will regress on their own; on the other hand, you don’t want to undertreat the ones that don’t have the kind that will go away.” Leukemia, the second most common cancer in infants, also behaves differently in infants than in older children. According to Michael Rytting, M.D., an assistant professor in the Division of Pediatrics and a specialist in treating pediatric leukemia, infants with leukemia generally have a worse prognosis than older children, and the poorer prognosis has a genetic link. “Infants with leukemia frequently have a rearrangement of the MLL gene in the leukemia cell,” said Dr. Rytting. “This rearrangement is the principal difference between babies and older children with the disease, and it is known to be a poor prognostic factor.” Dr. Rytting explained that accurately diagnosing leukemia in infants can be difficult. “Some infants with trisomy 21 have a transient myeloproliferative disorder that looks very similar to leukemia,” he explained. “This illness frequently resolves on its own, though these children remain at high risk for leukemia later in life.
“When the MLL rearrangement is involved, it takes a little longer to achieve remission than you might see with older children, and resistant disease probably is more common,” said Dr. Rytting. “These patients tend to be negative for CD10, the common acute lymphocytic leukemia antigen, and those patients are known to not do very well. However, the small group of infants who are positive for CD10 and do not have the MLL rearrangement do almost as well as other older children, so it is important to make that distinction.” Specialized care is best Regardless of the type of cancer, experts agree that treatment of infants is best handled in a highly specialized environment. “Babies present a challenge and really should be treated in a center that can meet their distinctive needs,” Dr. Rytting said. For parents, having access to nonmedical support staff who specialize in pediatric cancer can ease the strain during a very difficult time. “For young and sometimes inexperienced parents, having an infant with cancer can be a very shocking emotional experience, so we have a lot of support staff to help,” said Dr. Ater. For instance, M. D. Anderson psychologists developed a program called “Maternal Problem Solving” to help mothers learn to cope with catastrophic illness. “We’re very geared toward helping young parents through problematic times when their baby is diagnosed with cancer,” Dr. Ater concluded. “It just makes things a little easier.”For more information on this topic or for questions about M. D. Anderson’s treatments, programs, or services, call askMDAnderson at (877) MDA-6789. Other articles in OncoLog, November 2004 issue:
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