Infectious Complications

Philip A.
Pizzo
,
MD
National Cancer Institute

Forum Description

Sessions:

  1. Antibiotic Therapy – Current Issues and Future Research Questions
  2. Antifungal, Antiviral and Antiparasitic Therapy
  3. General Care and Management Issues
  4. Improving Host Defenses

In spite of the enormous progress made in the treatment of childhood cancer, infectious complications, arising as a consequence of cyotoxic and immunosuppressive therapy, remains a major source for morbidity in children undergoing cancer therapy and can be an impediment to the delivery of cancer treatment. The Forum will focus on the practical issues that arise in the management of infectious complications, including the selection and use of antibiotic therapy. Because the cancer patient is immunosuppressed, infection with unusual organisms, commonly referred to as opportunists, can be a serious problem. Thus, the focus will also consider the advances and appropriate utilization of antifungal, antiviral and antiparasitic therapies.

In addition to considering ways to manage the microbes causing infection, recent developments in molecular biology and immunology now offer the prospect for improving or restoring the very immune system that cancer treatment can abrogate. The application of these new tools, referred to as biological response modifiers or cytokines, will also be considered in detail. The goal of the Forum will be to consider how advances in antimicrobial therapy and in the development of biologicals can be integrated to reduce the risk for infection and to improve the outcome of those infections which do occur.

Forum Summary

Infectious complications remain a major cause of morbidity in children with cancer. This is a consequence of the abnormalities in the host defense system that result from both the cancer itself as well as the treatments used to control it. Unfortunately, the risk for such infections can limit the ability to deliver potentially beneficial cancer therapy. Thus, strategies to both treat these infectious disease complications as well as to prevent them are integral to the practice of pediatric oncology.

Accordingly, during the 1989 Forbeck Forum, clinicians and scientists from around the world gathered to develop a blueprint for the important research questions that will need to be addressed to improve the management and prevention of the infectious complications that are associated with cancer and its treatment. The initial discussion focused on the ways in which developments in antibiotic research influence clinical practice both now and in the future. Arthur Brown from Memorial Sloan- Kettering Hospital in New York and Ben di Pauw from the University of Nijmegen in the Netherlands considered the array of new antibiotics that became available during the 1980’s and considered the ways in which these agents should be used to optimize therapy. Importantly, the group focused on the methodology that is essential in conducting state-of-the-art clinical research. The relevance of these considerations to the deliberations of the Immunocompromised Host Society’s Consensus Panel that was chaired by Phil Pizzo in June of 1988 and to the Infectious Disease Society of America’s Consensus Report coordinated by Walter Hughes were considered. It was recognized that appropriate therapy really required an improvement in the ability to define which patients were at the highest risk for prolonged immunosuppression. This would not only help in the considerations regarding the initial management of patients who become febrile while they were neutropenic (i.e. low blood counts), but also in the appropriate modifications of this therapy should neutropenia and fever persist. This aspect of the discussion was led by Gerry Donowitz of the University of Virginia and Mary Ann Jackson from the University of Kansas. One of the major problems in patients with persistent neutropenia is fungal infections. Some of the advances in the diagnosis and treatment of these invasive fungal infections were discussed by Tom Walsch of the NCI and Gabriel Lopez-Berenstein of the MD Anderson Hospital. Some of the newer anti-fungal drugs offer particular benefit to cancer patients and strategies to study them were discussed.

In addition to infections caused by bacteria and fungi, viruses and protozoal infections can also be problematic for cancer patients. The major viral infections were discussed along with some recent advances in their treatment. Joel Meyers of The Fred Hutchinson Cancer Center led this discussion and the group agreed that cooperative studies to evaluate antiviral agents in children with or at risk for chickenpox (varicella) should be undertaken. In addition, Walter Hughes of the St. Jude Children’s Research Hospital led a discussion on new developments in the diagnosis and treatment of pneumocysistis infections. These are problems not only for children with cancer but also for those with AIDS. Plans for cooperative trials were discussed.

During the last decade, many new devices have been introduced to simplify the management of cancer patients. Foremost among these are surgically implanted indwelling intravenous devices. These make the administration of medications simpler and pain-free, improving the quality of life for children. At the same time, these devices are associated with infections and can pose a challenge to the oncologist. Claudio Viscoli from Italy discussed the problems with the diagnosis and management of these devices. In addition, Leigh Donowitz from the University of Virginia broadened the discussion to consider other strategies to prevent infectious complications in cancer patients.

One of the most exciting areas of development is the emerging field of biologicals. The revolution in molecular biology has led to the synthesis of molecules that can boost the immune system or accelerate the recovery of the bone marrow following chemotherapy. The role of antibody replacement in improving host defense was considered by Donna Ambrosino from Harvard and was coupled with discussions of lymphokines and cytokines (molecules that stimulate immune cells or bone marrow cells) by Art Ammann from Genentech. The prospect that these new biological agents could be used to bolster the immune system and improve the treatment and prevention of infections was discussed with considerable excitement and interest. Indeed, if these new molecules fulfill their promise, they can contribute to revitalized ways to improve the treatment of childhood cancer as well. Plans to study these agents were discussed and shared among the Forbeck Panel.

Quotes from Participants
“We are back in our respective busy lives where there is so little time to review and ponder the questions and the potential answers to the care and treatment of cancer patients. This past weekend was a rare and wonderful opportunity to do just that. Many thoughts and challenges came out of those meetings which I hope will come to productive research focus over the next year. One of the most important immediate benefits is having met or truly got to know people interested in these issues from all over the world.” -- Leigh G. Donowitz, MD, University of Virginia, Charlottesville, VA

Several projects have been developing … the role of herpes simplex as a co-pathogen will be investigated as suggested by Dr. Ben de Pauw’s experience in the Netherlands … the affirmation of our experience by investigators such as Dr. DePauw and Dr. Walter Hughes … directly related to my participation on the 1989 Forum, the Children’s Mercy Hospital will be cooperating with a study utilizing an orally administered antifungal agent in pediatric cancer patients with fever and neutropenia. Dr. Tom Walsh from the National Cancer Institute is the senior investigator in this study and through our meeting at the Forum; the Children’s Mercy Hospital will be cooperating with a study utilizing an orally administered antifungal agent in pediatric cancer patients with fever and neutropenia. Dr. Tom Walsh from the National Cancer Institute is the senior investigator in this study and through our meeting at the Forum; the Children’s Mercy Hospital has become involved.” -- Mary Anne Jackson, MD, Children’s Mercy Hospital, Kansas City, MO

“I feel that the meeting at Moss Creek was a scientifically and personally rewarding activity … the atmosphere was absolutely conducive toward collegial interactions.” -- Gabriel Lopez-Berestein, MD, MD Anderson, Houston, TX

“As I now have less patient contact … conferences such as the past one, especially when they are outgrowths of individuals who have experiences the consequences of illness, are reminders of what our goals should be.” -- Arthur J. Amman, MD, Genentech, Inc., San Francisco, CA

“I want to thank you for your kind hospitality and outstanding organization of the 1989 Forbeck Forum. The meeting provided a platform for the development of critical concepts on management of infections in cancer patients. It also led to plans for meaningful research collaborations among the participants.” -- Thomas J. Walsh, MD, National Cancer Institute, Bethesda, MD

This was an intense but thoroughly enjoyable opportunity to review the ongoing problems of infections in the compromised host and share ideas with many of the national and international leaders in this area. I certainly was honored to have been included and have come away with research ideas that we may put into effect over the next year.” -- Gerald R. Donowitz, MD, University of Virginia, Charlottesville, VA

Venue & Travel Information

Hilton Head Island

Travel Forms

TRAVEL FORMS DUE:
October 2, 1989
submit travel form

Travel Policy

Please familiarize yourself with our policies and procedures for travel. We truly appreciate you taking the time to participate in this meeting. As you make your plans, please remember that we are a nonprofit organization dependent on donations and volunteers. We do NOT pay for upgrades, change fees, incurred costs resulting from a flight change, transportation to or from your local (home side) airport, meals or other incidentals.

  • Travel Confirmation will be sent out within 1 week of the meeting. This will include a hotel confirmation number, if there is one, and airport transfer details. We have to wait until we receive almost everyone’s travel to book airport transfer. Due to frequent airline changes, we wait until the week of the meeting to send this out.
  • Airport transfer is provided by Foundation staff, volunteers or arranged shuttle at specific times. If you opt to utilize Foundation airport transportation on your travel form, please be patient in receiving this information. We will send it to the week of the meeting.
  • Speaker agenda is not sent out prior to the meeting. It will be provided upon arrival in the meeting packet. We do not tell people when they are speaking because we expect everyone to attend all sessions. Sessions are all day Friday and Saturday.
  • REMINDER: We do not reimburse for home side airport transfer or incidentals while traveling. We will not honor miscellaneous receipts sent for these expenses.
  • Spouses are welcome to come with you at their own cost but are not allowed to attend the meeting. Please no children.

What the Foundation Pays

Accommodations and meals are provided by the foundation during the meeting. Airfare will be covered only if booked through our travel agent. The Foundation will also cover airport transportation on the meeting side at the designated shuttle times. You can select not to utilize Foundation arranged transportation at your own expense when completing the travel form. Once your travel form is received your accommodations and airport transfer will be confirmed. Please let us know of any food allergies or other information we should be aware of on the travel forms.

  • If you would like your airfare covered by the Foundation, you must book with our travel agent. Note we do not cover upgrades, changes, late bookings, etc.
  • Flights must be booked at least 30 days prior to the meeting to confirm your accommodations and airport transfer.
  • As a nonprofit we utilize volunteers and other methods to maximize our efforts (or our donor support) when making accommodations and arranging ground transportation. Ground transportation will be provided upon your arrival either by a foundation volunteer or arranged shuttle. You will be provided airport transportation information the week of the meeting. We do not reimburse for home side airport transfer or incidentals while traveling.

Abstracts

Abstracts are due 30 days prior to the start of the meeting to allow enough time to prepare the meeting book.

The abstracts should be only one or two paragraphs outlining the theme of your presentation and should reflect the objective and spirit of the meeting (see above). Abstracts will be circulated about one week before the meeting. The meeting organizer will start requesting them a month before the meeting.

abstracts DUE:
October 2, 1989
submit abstract

Meeting Structure

The meeting structure has been developed over years of experience.

  • Participants have approximately 45 minutes, depending on the number of participants, for their presentation and discussion. The presentation is meant as a conversation start and should last about twenty minutes briefly covering background information and areas that are new or need further input. This should be structured in such a way as to lead to a lively discussion. Participants are encouraged to interrupt to ask questions or start discussions.
  • A MAXIMUM of 5 slide equivalents per presentation is allowed (Power point slides should not contain more than one graph or gel per slide and no more than 5 bullet points to stress the points being made by the presenter.) We appreciate cooperation with the spirit of this guideline. Handouts are welcome but should be distributed before sessions.
  • Everyone is expected to actively participate in every session and discussions.
  • The time spent at the meeting is relatively short, so please be familiar with papers received prior to the meeting.
  • It is very important that you commit to all sessions of the 2 days of meetings.

Forbeck Scholars Participation

Scholars are selected for each Forbeck Forum. These are outstanding junior clinical or post-doctoral fellows selected based on the quality and relevance of science.

  • Scholars present for 30-45 minutes, depending on the number of participants
  • The same presentation rules apply for scholars
  • After the Forum you are selected to attend, you will attend three years of Scholar Retreats held in Lake Geneva, WI. If you attend a Fall Forum, you will attend the Spring Retreat. If you attend a Spring Forum you will attend a Fall Retreat.
  • Scholars are selected by the Foundation Scientific Advisory Board and peer reviewers selected from past Forbeck Scholars.

General Program

The outline below illustrates a typical program schedule. You will receive a complete schedule, including speaking times, the Thursday the meeting starts.

Arrival Day
1:00 PM Arrivals
6:00 PM Cocktails (opt'l)
7:00 PM Dinner
Meeting Day 1
7:00 AM Breakfast
8:00 AM Scientific Sessions
12:00 PM Lunch
1:30 PM Scientific Sessions
6:00 PM Cocktails & Dinner
Meeting Day 2
7:00 AM Breakfast
8:00 AM Scientific Sessions
12:00 PM Lunch
1:30 PM Scientific Sessions
6:00 PM Cocktails & Dinner
Departure Day
7:00 AM Breakfast
8:00 AM Departures

Frequently Asked Questions

Below are some of our most Frequently Asked Questions. If you have something new to ask, please feel free to contact us.

  • Travel Confirmation will be sent out within 1 week of the meeting. This will include a hotel confirmation number, if there is one, and airport transfer details. We have to wait until we receive almost everyone’s travel to book airport transfer. Due to frequent airline changes, we wait until the week of the meeting to send this out.
  • Airport transfer is provided by Foundation staff, volunteers or arranged shuttle at specific times. If you opt to utilize Foundation airport transportation on your travel form, please be patient in receiving this information. We will send it to the week of the meeting.
  • Speaker agenda is not sent out prior to the meeting. It will be provided upon arrival in the meeting packet. We do not tell people when they are speaking because we expect everyone to attend all sessions. Sessions are all day Friday and Saturday.
  • Frequently airport transfer is provided by volunteers. Please be patient on receiving this information. Airport transfer will be sent out prior to arrival.
  • REMINDER: We do not reimburse for home side airport transfer or incidentals while traveling. We will not honor miscellaneous receipts sent for these expenses.

Forum Participants

Donna
Ambrosino
,
MD
Dana-Farber Cancer Institute
Arthur
Amman
,
MD
Genentech
Arthur E.
Brown
,
Memorial Sloan Kettering Cancer Center
Ben
de Pauw
,
MD
University Hospital Nijmegen
Gerald R.
Donowitz
,
MD
University of Virginia
Walter
Hughes
,
MD
St. Jude Children's Research Hospital
Mary Anne
Jackson
,
MD
Children's Mercy Kansas City
Gabriel
Lopez-Bernstein
,
MD
MD Anderson Cancer Center
Joel
Meyers
,
MD
Fred Hutchinson Cancer Research Center
Philip A.
Pizzo
,
MD
National Cancer Institute
Marc
Rubin
,
MD
National Cancer Institute
Claude
Viscoli
,
MD
Gaslini Children's Hospital
Thomas J.
Walsh
,
MD
National Cancer Institute

Forum Scholars

Stephen Chanock, MD
National Cancer Institute