CCG has the expertise to combine whole group protocol studies with small intra-group investigations of tumor biology. Large scale clinical programs are needed to consolidate data accrual of the past decade. Included in small group studies are those utilizing data on experiments in nature, i.e., adenosine deaminase (ADA) deficiency; anti-cancer effects of interferon; anti-tumor antibodies (common ALL, neuroblastoma); transplantation (allogeneic, autologous) biology; autologous lymphocyte therapy; radiosensitizer therapy; limb salvaging techniques/aggressive metastatic surgical attack; and diagnostic imaging procedures. Induced ADA deficiency can be applied to the study of T-cell leukemia and to the nature of lymphoblast modulation. Interferon data can be applied to the study of non-T ALL, non-Hodgkin's lymphoma and osteosarcoma and to the nature of tumor cell death. Anti-(common) ALL antibody studies can be applied to the development of common ALL and non-T, non-B lymphoma protocols. Specific anti-neuroblastoma antibody data can be applied to the development of randomized studies comparing chemotherapy and chemotherapy plus adjuvant antibody therapy. Allogenic transplantation for AML can be expanded to relapsing high risk ALL and high risk lymphoma. Autologous marrow transplantation rescue is applicable for megadose therapy studies of leukemia, lymphoma and a variety of solid tumors and as a means of evaluating techniques for identifying occult tumor burdens. Similarly, autologous lymphocyte infusion into brain tumors can test the hypothesis that such malignancies occupy immunologically priviledged sites and in turn be incorporated into a randomized radiosensitizer therapy study. Conflicting osteosarcoma data can be resolved by comparing pre-op megadose therapy to surgery alone (including evaluation of transfer factor, limb salvaging, and evaluation of the time/therapy sequence in treatment of metastatic disease). Extensive investigation of new agents is required in high risk Wilms' and Ewing's sarcoma and rhabdomyosarcoma. Efficacy studies of appropriate imaging techniques are mandated in virtually all protocols in which tumor delineation is essential. And in all studies active participation by nurse specialists should be encouraged in order to enhance protocol development.
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