Understanding the biology of pediatric hematologic cancer development through:
• Insights from epigenetics: In all hematologic malignancies, including acute and chronic leukemias, and lymphomas, there are both inherited and somatic genetic alterations that contribute to predisposition, transformation, and disease progression. While genomics plays a significant role in the onset and progression of such malignancies, it is becoming increasingly evident that epigenetic mechanisms are also heavily involved in oncogenesis. For instance, mutations in epigenetic modifiers are the most common alteration found in pediatric acute lymphocytic leukemia (ALL) at relapse, and while there are high upfront cure rates of pediatric ALL, the cure rates of relapsed pediatric ALL patients remain dismal. Insights from epigenetics could help investigators further understand the molecular mechanisms involved in normal and malignant cell development. Through the sharing of epigenetic data, investigators could begin to understand how epigenetic dysregulation in children and young adults contributes to hematologic cancer initiation, transformation, and evolution.
• Correlation of cancers with other hematologic diseases: There is a need for data to understand the pathophysiologic mechanisms that increase the risk of coagulopathies in pediatric patients with cancers. Given that the prevalence of venous thromboembolism (VTE) continues to increase in the pediatric oncology population (with adolescents and young adults being the population at high risk of developing VTE) and because there is limited information regarding the impact of VTE on pediatric cancer outcome, leveraging data from existing adult cancer studies investigating this issue could elucidate the correlation between cancer and thrombosis in this patient population.