This proposal is for continuation of research into the natural history, treatment and epidemiology of the statistical conduct, design, collation, and publication of childhood cancer. It will continue to emphasize multimodal aspects of the Children's Cancer Study Group which has realized such excellent results in the past in Wilms' tumors and rhabdomyosarcoma and has now helped in defining acute childhood lymphocytic leukemia as more than one disease entity which requires different treatments for different groups. Also, treatment has been improved in osteogenic sarcoma and Ewing's sarcoma and, though advances are more meager, there have also been statistical improvements in survival of neuroblastoma patients. Childhood nonlymphocytic leukemia patients have also shown improved survival and the Children's Cancer Study Group has now combined in a Groupwide study to compare bone marrow transplantation in first remission to more standard conventional chemotherapy in a controlled fashion. During the period from November, 1976 to December, 1979, 389 children with childhood cancer were seen at this institution; 182 with leukemia, 148 who were treated on study, 44 who were not on study, and 207 children with solid tumors. We have been a member of the Children's Cancer Study Group since 1959 and strong permanent referral patterns have been established. It is therefore anticipated that the patient load will continue to be stabilized and slightly increased over the next several years. A close working relationship with the adult leukemia center under Dr. E. Donnall Thomas at the Fred Hutchinson Cancer Research Center continues. This includes the exchange of professional personnel on the Fellowship level. Forty-three bone marrow transplantations on children with acute leukemia have been done at this institution from 11/1/76 to 12/1/79. Collaborative studies continue in immunology with the Fred Hutchinson Cancer Research Center, primarily through the efforts of Irwin D. Bernstein, M.D.
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