Home » When the Pieces Come Together
2010 | Issue 2 – Excerpt from Shine Magazine, Texas Children’s Hospital
By Kevin Harwerth
Developing a treatment plan for cancer is like working a jigsaw puzzle. Oncologists must fit together different forms of chemotherapy, radiation and surgery. The key to solving the puzzle lies in determining which combinations of treatments will prove most effective for a particular cancer.
The world-renowned oncologists at Texas Children’s Cancer Center—experts in treating cancers that range from the most common to the extremely rare—are used to solving puzzles. They have pioneered many of the standard protocols for treating and curing all types of pediatric cancer and blood disorders.
Most importantly, the Cancer Center shares these strategies with their colleagues across the nation to ensure that oncologists at other centers have the evidence-based treatment plans required to provide every child with the highest quality of care. And it is this particular piece of the puzzle that has made the difference for Ryan and Jennifer Martino and their son, Quentin.
Looking at pictures of Quentin—taken just before his 1st birthday—it is hard to believe that the happy little boy captured in those images was already suffering from one of the most deadly types of childhood cancer.
Only seven days before he turned 1, Quentin was diagnosed with acute lymphoid leukemia (ALL)—a form of leukemia that attacks the bone marrow and causes the production of too many white blood cells. These immature cells are inefficient at fighting infections and begin to crowd out healthy white blood cells, red blood cells and platelets. This can lead to infection, anemia and easy bleeding.
While ALL is the most common pediatric cancer, the disease in infants younger than 1 year is both rare and biologically different than what is found in older children. While survival rates for childhood leukemia have dramatically improved over the past 30 years, the outlook for the tiniest sufferers of this disease has generally been very grim.
At the time of Quentin’s diagnosis, the Martino family was living in New Jersey. Quentin began his treatment at a relatively small hospital near their home where, thankfully, Texas Children’s work in the field of ALL had already made an impact. When the family decided to relocate to Houston to follow a career opportunity, they made sure Quentin’s new oncologist was the woman who literally wrote the book on the regimen he was receiving.
ZoAnn Dreyer, M.D., pediatric hematology/oncology specialist and chief of the long-term survivor program at Texas Children’s Cancer Center and Hematology Service, is an expert in the treatment of ALL in infants younger than 1 year of age.
Most importantly for Quentin and other infants suffering from this devastating disease, Dreyer served as the principal investigator for an innovative, nationwide treatment protocol that has increased cure rates for this population from about 20 percent to more than 50 percent.
Traditionally, infants with ALL were treated with a prolonged course of therapy—almost two and a half years—but 60 percent to 80 percent of patients relapsed after treatment. Based on this information, Dreyer helped develop a new protocol that radically changed the approach to treating infant leukemia. Dreyer began a pilot program that called for intensified levels of a chemotherapy never before used on infants to be delivered over the course of 46 weeks.
“Knowing that infant leukemia is very aggressive and comes back very quickly, we developed a treatment to match the aggressiveness of the disease,” said Dreyer, associate professor of pediatrics – hematology/oncology at Baylor College of Medicine. “This high-impact, short-term therapy is now the standard of care across the country for infants with ALL.”
Dreyer and her team have observed that the children on this therapy rarely have an early relapse. Additionally, most survivors have not demonstrated long-term side effects. Dreyer and her colleagues believe that this strategy—a shortened, intensified therapy—could someday be applied to other aggressive forms of leukemia.
“It’s remarkable to see children who are diagnosed, treated and enjoying childhood—many of whom might have had a different outcome without this new protocol,” said David Poplack, M.D., director of Texas Children’s Cancer Center and Hematology Service and holder of the Elise C. Young Chair of Pediatric Oncology at Baylor College of Medicine. “As the largest pediatric cancer and hematology research and treatment center in the United States, we are able to develop novel therapies, design new treatment plans and then share our knowledge with our colleagues around the world—all for the benefit of the children.”
Dreyer and her team continue to work to improve the outlook for infants with ALL. Building on the foundation of the treatment that Quentin underwent, Dreyer is currently evaluating the protocol to see if new treatments would be even more effective.
The Martinos know the need for continuing to advance treatments for infants who suffer from ALL. “When your child is undergoing treatment for cancer, you spend a lot of time in the hospital, and you get to know the other families whose children are undergoing treatment very well,” said Quentin’s mom, Jennifer Martino. “Unfortunately, of the families we met, very few children with the same disease as Quentin survived their cancer.”
Quentin finished his treatments two years ago and today remains cancer free, but beating his cancer was only one challenge he faces.
Quentin showed an incredible aptitude for language at an early age—even learning sign language at 2 years old. It turned out that this is one of the atypical behaviors that led to a diagnosis of pervasive developmental disorder – not otherwise specified (PDD NOS)—part of the autism spectrum disorders. Quentin also showed signs of repetitive behavior; he had difficulties socializing, was oversensitive to certain stimuli and was hyperlexic.
Most children learn how to talk on their own, simply by being surrounded by spoken language. Then, after they’ve been talking for a while, someone teaches them how to read. Children with hyperlexia are just the opposite. They learn how to read simply by being surrounded by printed words, but even after they have become fluent readers, someone has to make a deliberate effort to teach them verbal communication skills.
Texas Children’s has been a resource for the Martino family through Quentin’s cancer and someday may be able to help families like his with neurological conditions as well.
The hospital’s Jan and Dan Duncan Neurological Research Institute is attracting some of the finest scientific minds from around the world to solve some of the most complicated puzzles behind pediatric neurological disorders.
Dr. Mirjana Maletic-Savatic in front of the Jan and Dan Duncan Neurological Research Institute at Texas Children’s Hospital
Mirjana Maletic-Savatic, M.D., Ph.D., child neurologist at Texas Children’s Hospital and one of the Institute’s first recruits, sees children with autism—most who are lower-functioning than Quentin. As a leading researcher in the field, she has developed a new, noninvasive way to image a biomarker that will enable researchers to monitor neurogenesis—the process by which neurons are created. It holds enormous promise for helping create better diagnostics and treatments for autistic spectrum disorders as well as for numerous central nervous system disorders like multiple sclerosis, Parkinson’s disease and cerebral palsy.
Since early intervention is instrumental in the long-term success of children with PDD NOS and autism spectrum disorders, advances that lead to an accurate and early diagnosis hold great potential to have an immediate impact.
Savatic said, “My goal is to form a multidisciplinary program with a common goal of finding biomarkers of autism to help diagnose the disorder early and find clues that might help treatment of children who suffer from the disease.”
The treatment that Dreyer developed for cancer has given kids like Quentin a second chance—kids who just a few years ago had little hope. Much like Dreyer’s work with ALL in infants, Savatic’s research through the Institute may someday lead to the protocol for treating autism and conditions like Quentin’s.
Once uncovered, that knowledge will be shared with children’s hospitals and care centers across the nation and world.
For now, Quentin continues to receive therapy for his PDD NOS through his school, the Parish School. At 4½ years old, he doesn’t worry about the cancer he survived or the lifelong intervention he will continue to face for his neurological condition. He’s happy playing music with his mom and basketball with his dad. He also excels at working puzzles—something he has in common with the physician-scientists at Texas Children’s Hospital.
“In order for Quentin to be the happy, active child he is today took the effort of scores of individuals” says Martino. “We are so appreciative of the efforts of Dr. Dreyer and her team, the volunteer blood donors who made it possible for Quentin to receive more than 40 transfusions of blood products during his leukemia treatment, the nurses who held our hands throughout his time at Texas Children’s, as well as the researchers who continue to search for new ways to help children with cancer and autism.”
Shine, Texas Children’s Hospital’s publication of patients, progress and philanthropy at Texas Children’s Hospital, is produced by the Office of Development. Three times a year, Shine brings you the stories behind the patients, families, physicians, scientists, supporters and leaders who make Texas Children’s Hospital one of the best pediatric hospitals in the nation. Their stories are our story—of how far we’ve come and of where we’re headed. View the full magazine here…
Pictured: Dr. ZoAnn Dreyer examines patient Quentin Martino, 4