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CME: The present and emerging state of the pediatric acute lymphoblastic leukemia (ALL) treatment landscape

Activity Description / Statement of Need:

In this online, self-learning activity:

Advances in ALL management has led to considerable improvements in outcomes over the past several years, with modern-day treatment leading to remission rates of up to 99% and cure rates of about 90% in children with ALL. However, achieving these high rates of response require multiple phases of treatment, including induction, consolidation, interim maintenance, delayed intensification, and maintenance therapy. 

Chemotherapy was previously the standard of care in this setting but is associated with considerable toxicities. Novel, less toxic options are available or being studied for children who have relapsed after treatment as are new pharmacotherapies specific to patients with Philadelphia chromosome–positive disease and novel formulations of asparaginase. Helping the clinician discern the role of each of the first- and subsequent-line novel therapies based on the most up-to-date research merits continuing education programming in ALL. Indeed, a survey of oncology providers revealed that 86% indicated that added professional guidance would be helpful in incorporating more recent therapies into care.

And despite the inclusion of newer agents in pediatric ALL guidelines, a survey of oncologists and other providers who treat patients with the condition found that 40% of respondents had never prescribed, dispensed, or administered them. Challenges include lack of expertise and management of side effects. Furthermore, recently published guidelines, therefore, also inherently suggest a gap in medical practice and justify the need for educational programming.

Target Audience:

HCPs specializing in: pediatric hematology-oncology, hematology, oncology, pathology, and those who otherwise commonly care for or clinically encounter pediatric patients with ALL.


Commercial Support Disclosure: This program is supported by an educational grant from AMGEN.

This activity is free of charge.


Release Date: August 31, 2022 -- Expiration Date: August 31, 2023

Faculty: Joseph Rosenthal, MD, JD

Agenda

Faculty introduction, disclosures

Introductory content: cursory refresher and review

  • ALL: estimated new cases by age distribution
  • ALL outcomes in pediatric populations
  • Staging and risk assessment
    • Morphology, classification, and prognostic indicators
    • Treatment outcome by minimum residual disease group
  • Advances in molecular biology and impact on diagnosis – biomarker review and updates

Pediatric ALL management

  • NCCN-recommended principles of pediatric treatment approaches
    • Induction chemotherapy, consolidation therapy, and relapsed/refractory disease
    • Limitations of cytotoxic chemotherapy
    • Role for hematopoietic stem cell transplant
  • Treatment for patients with detectable MRD postinduction or postreinduction
    • Clinical trial
    • Chemotherapy
    • Bispecific antibody
    • CAR-T therapy
  • Treatment for relapsed disease
    • Clinical trial
    • Chemotherapy regimens
    • Bispecific antibody
    • CAR-T therapy
    • Off-label antibody-drug conjugate
  • Considerations for Ph+ ALL
    • TKIs to consider
    • Treatment for TKI intolerant or refractory
  • Additional considerations: optimizing and managing asparaginase therapy
  • Supportive care and patient/parent education
  • Patient cases

Summary, conclusions, and best practice recap

Learning Objectives

By the end of the session the participant will be able to:

  • Identify factors affecting the diagnosis, staging, and prognosis of children and adolescents with ALL.
  • Develop pediatric ALL treatment strategies based on the most up-to-date clinical trial findings.
  • Describe the risk-benefit calculus of ALL management strategies and apply them to patient cases, taking into account disease stage, prior treatment, past medical history, and prognostic indicators including detectable MRD.
  • Evaluate a treatment plan, making modifications if necessary, for a patient with ALL based on initial treatment response and the presence of MRD.

Accreditation

ACCME Activity #202333861

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through ScientiaCME. ScientiaCME is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation: ScientiaCME designates this educational activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™ toward the AMA Physician's Recognition Award. Physicians should only claim credit commensurate with the extent of their participation in the activity.

CME-MOC_badge

ABIM MOC Recognition Statement: Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.0 MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

ABIM MOC Credit Type: Medical Knowledge

ABP MOC Recognition Statement: Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.0 MOC points in the American Board of Pediatrics' (ABP) Maintenance of Certification (MOC) program. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting AP MOC credit.

ABP MOC Credit Type: Medical Knowledge

Physicians: For maintenance of certification (MOC) points, you must enter your board certification ID # and birth date correctly.  It is the learner's responsibility to provide this information completely and accurately at the completion of the activity. Without providing it, the learner will NOT receive MOC points for this activity. By providing this data, you acknowledge that it will be shared with ACCME and the applicable certifying board. Please note: Not all activities on this site provide MOC points. If this activity does not specify that it provides MOC points in this section, then it does NOT provide MOC points. This activity provides MOC points only for ABIM.

Pharmacists

ScientiaCME is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education. This activity is approved for 1.0 contact hours (0.1 CEUs) of continuing pharmacy education credit. Proof of participation will be posted to your NABP CPE profile within 4 to 6 weeks to participants who have successfully completed the post-test. Participants must participate in the entire presentation and complete the course evaluation to receive continuing pharmacy education credit. ACPE #0574-0000-22-049-H01-P. This is an knowledge (K)-type activity. 

PharmacistsYou must enter your NABP # and birth date correctly so that proof of participation can be posted to your NABP CPE profile. It is the learner's responsibility to provide this information completely and accurately at the completion of the activity. Without providing it, the learner will NOT receive CPE credit for this activity.

Nurse Practitioners (NPs): The American Academy of Nurse Practitioners accepts AMA PRA Category 1 Credit(s)™ from organizations accredited by the ACCME. ScientiaCME will provide NPs who successfully complete each activity with a certificate of participation indicating that the activity was designated for AMA PRA Category 1 Credit(s)™.

Physician Assistants: The American Academy of Physician Assistants accepts AMA PRA Category 1 Credit(s)™ from organizations accredited by the ACCME.


Faculty Disclosure and Resolution of COI

As a provider of continuing medical education, it is the policy of ScientiaCME to ensure balance, independence, objectivity, and scientific rigor in all of its educational activities. In accordance with this policy, faculty and educational planners must disclose any significant relationships with commercial interests whose products or devices may be mentioned in faculty presentations, and any relationships with the commercial supporter of the activity. The intent of this disclosure is to provide the intended audience with information on which they can make their own judgments. Additionally, in the event a conflict of interest (COI) does exist, it is the policy of ScientiaCME to ensure that the COI is resolved in order to ensure the integrity of the CME activity. For this CME activity, any COI has been resolved thru content review by ScientiaCME.

Faculty DisclosureJoseph Rosenthal, MD, Barron Hilton Professor and Chair in Pediatrics, Director, Pediatric Hematology/Oncology, City of Hope National Medical Center, has no relevant financial disclosures.

Disclosures of Educational Planners: Charles Turck, PharmD, BCPS, BCCCP, President of ScientiaCME, has no relevant financial disclosures.

Faculty will NOT discuss off-label uses.

All relevant financial relationships have been mitigated.

ScientiaCME adheres to the ACCME’s Standards for Integrity and Independence in Accredited Continuing Education. Any individuals in a position to control the content of a CE activity, including faculty, planners, reviewers or others are required to disclose all relevant financial relationships with ineligible entities (commercial interests). All relevant conflicts of interest have been mitigated prior to the commencement of the activity.

Commercial Support Disclosure: This program is supported by an educational grant from AMGEN.

Instructions

  • Read the learning objectives above
  • Take the Pre-Test (optional). Completion of the pre-test will help us evaluate the knowedge gained by participating in this CME activity.
  • View the online activity. You may view this is in more than one session, and may pause or repeat any portion of the presentation if you need to.
  • Minimum participation threshold: Take the post-test. A score of 70% or higher is required to pass and proceed to the activity evaluation.
  • Complete the activity evaluation and CME registration. A CE certificate will be emailed to you immediately.

Cultural and Linguistic Competence

System Requirements

PC
Windows 7 or above
Internet Explorer 8
*Adobe Acrobat Reader
MAC
Mac OS 10.2.8
Safari or Chrome or Firefox
*Adobe Acrobat Reader
Internet Explorer is not supported on the Macintosh

*Required to view Printable PDF Version


Perform Pre-Test (optional)

Please take a few minutes to participate in the optional pre-test. It will help us measure the knowledge gained by participating in this activity.


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