Tumor Genomic Profiling and Ex Vivo Drug Sensitivity Testing for Pediatric Leukemia and Lymphoma Patients.

OBJECTIVE: To describe the frequency of use of tumor genomic profiling and functional ex vivo drug sensitivity testing in pediatric patients with hematologic malignancies at our institution, and to determine how the results affected treatment selection. METHODS: A retrospective chart review was conducted to analyze the frequency of tumor genomic profiling and functional drug sensitivity screening in our institution in pediatric patients with hematologic malignancies and to ask if the results were used to direct treatment. A case series of patients for whom these testing recommendations resulted in therapeutic interventions is reported. RESULTS: Thirty-three patients underwent tumor genomic profiling assays, functional ex vivo testing, or both. Nineteen patients (58%) had genomic profiling assays performed alone, 3 (9%) had functional ex vivo testing performed alone, and 11 (33%) had both tests performed. Twenty-one (64%) patients had potentially actionable mutations detected by the genomic profiling assay. Seven (21%) patients received at least 1 chemotherapeutic agent in accordance with the tumor genomic profiling or functional ex vivo drug sensitivity testing results. Three (43%) of the 7 patients who were treated with testing directed therapy had a favorable treatment response (PR or CR) to treatments selected based upon results of genomic or functional ex vivo testing. CONCLUSIONS: This retrospective case series demonstrates that precision medicine techniques such as genomic profiling and drug sensitivity testing can positively inform treatment selection in pediatric patients with relapsed or refractory leukemia and lymphoma.

Comparison of Rapid Hydration and Standard Hydration Prior to Ifosfamide Administration in Pediatric Patients: A Safety and Efficacy Study.

OBJECTIVES: Adequate hydration status prior to chemotherapy initiation prevents nephrotoxicity in patients receiving potentially nephrotoxic regimens. The purpose of this study was to evaluate the time to initiation of ifosfamide administration between patients receiving standard 6-hour pre-hydration versus 1-hour rapid pre-hydration. METHODS: A retrospective study was conducted to determine the primary endpoint of time to ifosfamide administration. Patients 1 to 21 years of age who received ifosfamide with standard 6-hour pre-hydration (125 mL/m2/hr for 6 hours) between September 2017 and January 2018 or 1-hour rapid pre-hydration (750 mL/m2/hr for 1 hour) between September 2018 and March 2019 were included. Secondary endpoints included the incidence of hemorrhagic cystitis, incidence of acute kidney injury (AKI), urine specific gravity, amount of time that ifosfamide was delayed from the originally scheduled administration time, the number of times ifosfamide was delayed greater than 4 hours from the originally scheduled administration time, and length of stay. RESULTS: A total of 128 patients were included; 68 patients received standard 6-hour pre-hydration and 60 patients received 1-hour rapid pre-hydration prior to ifosfamide administration. Time to ifosfamide administration was reduced from an average of 9.3 hours to 2.4 hours (p < 0.0001). There was no incidence of hemorrhagic cystitis or AKI in either group. CONCLUSIONS: The 1-hour rapid pre-hydration protocol significantly reduced the time to ifosfamide administration without an increase in adverse effects.