Update on Recommendations for Surveillance for Children with Predisposition to Hematopoietic Malignancy

Authors

Luke D Maese
Marcin W Wlodarski
Sun Young Kim
Alison A Bertuch
Gaelle Bougeard
Vivian Y Chang
Lucy A Godley
Payal P Khincha
Roland P Kuiper
Harry Lesmana
Rose B McGee
Lisa J McReynolds
Julia Meade
Sharon E Plon
Sharon A Savage
Sarah R Scollon
Hamish S Scott
Michael F Walsh
Kim E Nichols
Christopher C Porter

Publication Date

10-1-2024

Journal

Clinical Cancer Research

DOI

10.1158/1078-0432.CCR-24-0685

PMID

39078402

PMCID

PMC11444884

PubMedCentral® Posted Date

4-1-2025

PubMedCentral® Full Text Version

Author MSS

Published Open-Access

yes

Keywords

Humans, Genetic Predisposition to Disease, Child, Hematologic Neoplasms, Hematopoietic Stem Cell Transplantation, Myelodysplastic Syndromes, Practice Guidelines as Topic

Abstract

Children harboring certain germline gene variants have an increased risk of developing myelodysplastic syndrome (MDS) and other hematopoietic malignancies (HM), such as leukemias and lymphomas. Recent studies have identified an expanding number of these predisposition genes, with variants most prevalent in children with MDS but also found in children with other HM. For some hematopoietic malignancy predispositions (HMP), specifically those with a high risk of MDS, early intervention through hematopoietic stem cell transplantation can favorably impact overall survival, providing a rationale for rigorous surveillance. A multidisciplinary panel of experts at the 2023 AACR Childhood Cancer Predisposition Workshop reviewed the latest advances in the field and updated prior 2017 surveillance recommendations for children with HMP. In addition to general guidance for all children with HMP, which includes annual physical examination, education about the signs and symptoms of HM, consultation with experienced providers, and early assessment by a hematopoietic stem cell transplantation specialist, the panel provided specific recommendations for individuals with a higher risk of MDS based on the affected gene. These recommendations include periodic and comprehensive surveillance for individuals with those syndromes associated with higher risk of MDS, including serial bone marrow examinations to monitor for morphologic changes and deep sequencing for somatic changes in genes associated with HM progression. This approach enables close monitoring of disease evolution based on the individual's genetic profile. As more HMP-related genes are discovered and the disorders' natural histories are better defined, these personalized recommendations will serve as a foundation for future guidelines in managing these conditions.