The past five years in POG saw stablization and refinement in pre-existing studies and entirely new approaches to cancer care. Such endeavors mandate divisions of labor within groups and institutions in terms of accrual, scientific input, and institutional features. Aggressive up-front therapy is the most effective regimen for most malignant processes. Single agent therapy for resistant disease is eventually fruitless, and genetic information adapted into the fabric of therapy is becoming increasingly more vital to the development of effective treatment programs. At the U of F we have (1) increased basic science endeavors so as to address principles of therapy, and (2) developed FDA approved marrow purging techniques utilizing monoclonalantibodies and magnetic microspheres for treating high risk neuroblastoma, which resulted in a five fold increase in DFS. These pilot studies are now group-wide projects. These techniques when applied to treatment of cALLa were found to be wanting and a reapprisal was obviously mandated. Combination MoAb-microspheres in concert with chemotherapy purging is the reasonable choice for all such patients in whom allografting is not feasible. Our successful, unrelated donor marrow transplant program is available for group-wide use. We have competed the basic science for an approach designed to distinguish between Graft vs. Host Disease and Graft vs. Leukemia using MoAb to CD 8. Such studies have been successfully carried out in adults using anti-CD 8 and C. We have shown that high risk Ewing's sarcoma can be effectively treated with megadose therapy and marrow rescue and it, too, is ready for group-wide use. Our data on osteosarcoma therapy with four drug rotational therapy are no better than any other best therapy. The next o.s. study will include megadose therapy with marrow rescue prior to surgery. We have responded to POG's request to initiate bone marrow transplantation for brain tumors and lymphomas. We will continue to develop (1) long term marrow self-renewing culture systems, (2) growth factor studies and (3) polymerase chain reaction studies (for MRD detection) whilst actively participating in all POG programs as attested by our increased accural over the five year span during which time we absorbed by the Jacksonville (University Hospital/Nemours Clinic) institutions into our program, added a satellite (Miami Children's Hospital), and an affiliate, University of South Carolina at Charleston, efforts designed to be certain that no child with cancer is denied best available medicine at best available institutions.
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